Browsing by Author "Todd, Jim"

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    Correlates of previous couples’ HIV counseling and testing uptake among married individuals in three HIV prevalence strata in Rakai, Uganda
    (Global Health Action, 2015-06-08) Matovu, Joseph K. B.; Todd, Jim; Wanyenze, Rhoda K.; Wabwire-Mangen, Fred; Serwadda, David
    Background: Studies show that uptake of couples’ HIV counseling and testing (couples’ HCT) can be affected by individual, relationship, and socioeconomic factors. However, while couples’ HCT uptake can also be affected by background HIV prevalence and awareness of the existence of couples’ HCT services, this is yet to be documented. We explored the correlates of previous couples’ HCT uptake among married individuals in a rural Ugandan district with differing HIV prevalence levels. Design: This was a cross-sectional study conducted among 2,135 married individuals resident in the three HIV prevalence strata (low HIV prevalence: 9.7_11.2%; middle HIV prevalence: 11.4_16.4%; and high HIV prevalence: 20.5_43%) in Rakai district, southwestern Uganda, between November 2013 and February 2014. Data were collected on sociodemographic and behavioral characteristics, including previous receipt of couples’ HCT. HIV testing data were obtained from the Rakai Community Cohort Study. We conducted multivariable logistic regression analysis to identify correlates that are independently associated with previous receipt of couples’ HCT. Data analysis was conducted using STATA (statistical software, version 11.2). Results: Of the 2,135 married individuals enrolled, the majority (n_1,783, 83.5%) had been married for five or more years while (n_1,460, 66%) were in the first-order of marriage. Ever receipt of HCT was almost universal (n_2,020, 95%); of those ever tested, (n_846, 41.9%) reported that they had ever received couples’ HCT. There was no significant difference in previous receipt of couples’ HCT between low (n_309, 43.9%), middle (n_295, 41.7%), and high (n_242, 39.7%) HIV prevalence settings (p_0.61). Marital order was not significantly associated with previous receipt of couples’ HCT. However, marital duration [five or more years vis-a`-vis 1_2 years: adjusted odds ratio (aOR): 1.06; 95% confidence interval (95% CI): 1.04_1.08] and awareness about the existence of couples’ HCT services within the Rakai community cohort (aOR: 7.58; 95% CI: 5.63_10.20) were significantly associated with previous receipt of couples’ HCT. Conclusions: Previous couples’ HCT uptake did not significantly differ by HIV prevalence setting. Longer marital duration and awareness of the existence of couples’ HCT services in the community were significantly correlated with previous receipt of couples’ HCT. These findings suggest a need for innovative demand_creation interventions to raise awareness about couples’ HCT service availability to improve couples’ HCTuptake among married individuals.
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    Evaluation of a demand-creation intervention for couples’ HIV testing services among married or cohabiting individuals in Rakai, Uganda: a cluster-randomized intervention trial
    (BMC Infectious Diseases, 2016) Matovu, Joseph K. B.; Todd, Jim; Wanyenze, Rhoda K.; Kairania, Robert; Serwadda, David; Wabwire-Mangen, Fred
    Background: Uptake of couples’ HIV counseling and testing (couples’ HCT) services remains largely low in most settings. We report the effect of a demand-creation intervention trial on couples’ HCT uptake among married or cohabiting individuals who had never received couples’ HCT. Methods: This was a cluster-randomized intervention trial implemented in three study regions with differing HIV prevalence levels (range: 9–43 %) in Rakai district, southwestern Uganda, between February and September 2014. We randomly assigned six clusters (1:1) to receive the intervention or serve as the comparison arm using computer-generated random numbers. In the intervention clusters, individuals attended small group, couple and male-focused interactive sessions, reinforced with testimonies from ‘expert couples’, and received invitation coupons to test together with their partners at designated health facilities. In the comparison clusters, participants attended general adult health education sessions but received no invitation coupons. The primary outcome was couples’ HCT uptake, measured 12 months post-baseline. Baseline data were collected between November 2013 and February 2014nwhile follow-up data were collected between March and April 2015. We conducted intention-to-treat analysis using a mixed effects Poisson regression model to assess for differences in couples’ HCT uptake between the intervention and comparison clusters. Data analysis was conducted using STATA statistical software, version 14.1. Results: Of 2135 married or cohabiting individuals interviewed at baseline, 42 % (n = 846) had ever received couples’ HCT. Of those who had never received couples’ HCT (n = 1,174), 697 were interviewed in the intervention clusters while 477 were interviewed in the comparison clusters. 73.6 % (n = 513) of those interviewed in the intervention and 82.6 % (n = 394) of those interviewed in the comparison cluster were interviewed at follow-up. Of those interviewed, 72.3 % (n = 371) in the intervention and 65.2 % (n = 257) in the comparison clusters received HCT. Couples’ HCT uptake was higher in the intervention than in the comparison clusters (20.3 % versus 13.7 %; adjusted prevalence ratio (aPR) = 1.43, 95 % CI: 1.02, 2.01, P = 0.04). Conclusion: Our findings show that a small group, couple and male-focused, demand-creation intervention reinforced with testimonies from ‘expert couples’, improved uptake of couples’ HCT in this rural setting. Trial registration: ClinicalTrials.gov, NCT02492061. Date of registration: June 14, 2015.
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    ‘‘Men are always scared to test with their partners . . . it is like taking them to the Police’’: Motivations for and barriers to couples’ HIV counselling and testing in Rakai, Uganda: a qualitative study
    (Journal of the International AIDS Society, 2014) Matovu, Joseph K. B.; Wanyenze, Rhoda K.; Wabwire-Mangen, Fred; Nakubulwa, Rosette; Sekamwa, Richard; Masika, Annet; Todd, Jim; Serwadda, David
    Introduction: Uptake of couples’ HIV counselling and testing (couples’ HCT) can positively influence sexual risk behaviours and improve linkage to HIV care among HIV-positive couples. However, less than 30% of married couples have ever tested for HIV together with their partners. We explored the motivations for and barriers to couples’ HCT among married couples in Rakai, Uganda. Methods: This was a qualitative study conducted among married individuals and selected key informants between August and October 2013. Married individuals were categorized by prior HCT status as: 1) both partners never tested; 2) only one or both partners ever tested separately; and 3) both partners ever tested together. Data were collected on the motivations for and barriers to couples’ HCT, decision-making processes from tested couples and suggestions for improving couples’ HCT uptake. Eighteen focus group discussions with married individuals, nine key informant interviews with selected key informants and six in depth interviews with married individuals that had ever tested together were conducted. All interviews were audio-recorded, translated and transcribed verbatim and analyzed using Nvivo (version 9), following a thematic framework approach. Results: Motivations for couples’ HCT included the need to know each other’s HIV status, to get a treatment companion or seek HIV treatment together _ if one or both partners were HIV-positive _ and to reduce mistrust between partners. Barriers to couples’ HCT included fears of the negative consequences associated with couples’ HCT (e.g. fear of marital dissolution), mistrust between partners and conflicting work schedules. Couples’ HCT was negotiated through a process that started off with one of the partners testing alone initially and then convincing the other partner to test together. Suggestions for improving couples’ HCT uptake included the need for couple- and male-partner-specific sensitization, and the use of testimonies from tested couples. Conclusions: Couples’ HCT is largely driven by individual and relationship-based factors while fear of the negative consequences associated with couples’ HCT appears to be the main barrier to couples’ HCT uptake in this setting. Interventions to increase the uptake of couples’ HCT should build on the motivations for couples’ HCT while dealing with the negative consequences associated with couples’ HCT.