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      Factors that lead to changes in sexual behaviours after a negative HIV test: protocol for a prospective cohort study in Kinshasa

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          Abstract

          Background

          Considering the high percentage of couples in which one or both members are HIV negative, the frequency of transmission among non-regular partners and the probabilities of non-disclosure, attention should be paid to people getting a negative HIV test at the Voluntary Counseling and Testing (VCT). Research has shown that a negative HIV test may be followed by a change in sexual behaviours. In Sub-Saharan Africa, where most HIV infections occur, there are few studies that have analysed the factors associated with changes in sexual risk behaviours after a negative HIV test at the VCT clinic. The aim of this project is to evaluate the specific factors associated with changes in sexual behaviours, three months after a negative result in an HIV test, and to analyse the effect of counseling and testing on HIV-related knowledge of participants in an outpatient centre of Kinshasa (Democratic Republic of Congo).

          Methods and design

          Prospective cohort study from December 2014 until March 2016. People 15–60 year old that received VCT at Monkole Hospital (Kinshasa) were followed three months after they got a negative HIV test. In a face-to-face interview, participants replied to a baseline and a follow-up research questionnaire on HIV-related knowledge, attitudes and behaviours. At follow-up respondents were also offered a new HIV test and additional HIV counseling. Four hundred and fifteen participants completed the baseline questionnaire and 363 (87 %) came back for their 3-month follow up.

          Discussion

          This is the first longitudinal study in the DRC that evaluates the factors associated with changes in sexual behaviours after a negative HIV test at the VCT. Participants attending the VCT services within a clinical setting are a good study population as they can be good transmitters of preventive information for other people with no access to health facilities.

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          Most cited references57

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          The costs and effectiveness of four HIV counseling and testing strategies in Uganda.

          HIV counseling and testing (HCT) is a key intervention for HIV/AIDS control, and new strategies have been developed for expanding coverage in developing countries. We compared costs and outcomes of four HCT strategies in Uganda. A retrospective cohort of 84 323 individuals received HCT at one of four Ugandan HCT programs between June 2003 and September 2005. HCT strategies assessed were stand-alone HCT; hospital-based HCT; household-member HCT; and door-to-door HCT. We collected data on client volume, demographics, prior testing and HIV diagnosis from project monitoring systems, and cost data from project accounts and personnel interviews. Strategies were compared in terms of costs and effectiveness at reaching key population groups. Household-member and door-to-door HCT strategies reached the largest proportion of previously untested individuals (>90% of all clients). Hospital-based HCT diagnosed the greatest proportion of HIV-infected individuals (27% prevalence), followed by stand-alone HCT (19%). Household-member HCT identified the highest percentage of discordant couples; however, this was a small fraction of total clients (<4%). Costs per client (2007 USD) were $19.26 for stand-alone HCT, $11.68 for hospital-based HCT, $13.85 for household-member HCT, and $8.29 for door-to-door-HCT. All testing strategies had relatively low per client costs. Hospital-based HCT most readily identified HIV-infected individuals eligible for treatment, whereas home-based strategies more efficiently reached populations with low rates of prior testing and HIV-infected people with higher CD4 cell counts. Multiple HCT strategies with different costs and efficiencies can be used to meet the UNAIDS/WHO call for universal HCT access by 2010.
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            Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997.

            This study examined whether HIV counseling and testing leads to reductions in sexual risk behavior. The meta-analysis included 27 published studies that provided sexual behavior outcome data, assessed behavior before and after counseling and testing, and provided details sufficient for the calculation of effect sizes. The studies involved 19,597 participants. After counseling and testing, HIV-positive participants and HIV-serodiscordant couples reduced unprotected intercourse and increased condom use more than HIV-negative and untested participants. HIV-negative participants did not modify their behavior more than untested participants. Participants' age, volition for testing, and injection drug use treatment status, as well as the sample seroprevalence and length of the follow-up, explained the variance in results. HIV counseling and testing appears to provide an effective means of secondary prevention for HIV-positive individuals but, as conducted in the reviewed studies, is not an effective primary prevention strategy for uninfected participants. Theory-driven research with attention given to the context of testing is needed to further explicate the determinants of behavior change resulting from HIV counseling and testing, and the effectiveness of specific counseling approaches.
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              Sexual behavior of HIV discordant couples after HIV counseling and testing

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                Author and article information

                Contributors
                +34 948 425600 , scarlos@unav.es
                francis.nzakimuena@monkole.cd
                gabi@unav.es
                cldelburgo@unav.es
                eduburgue@gmail.com
                ado.ndarabu@gmail.com
                aosorio@unav.es
                jdeirala@unav.es
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                20 July 2016
                20 July 2016
                2016
                : 16
                : 606
                Affiliations
                [ ]University of Navarra, Department of Preventive Medicine and Public Health, C/Irunlarrea, 1. 31080 Pamplona, Spain
                [ ]IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
                [ ]University of Navarra, Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, Pamplona, Spain
                [ ]CECFOR/Monkole Hospital, Kinshasa, Democratic Republic of Congo
                [ ]University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
                [ ]Clinic University of Navarra, Clinical Microbiology Department, Pamplona, Spain
                [ ]University of Navarra, School of Education and Psychology, Pamplona, Spain
                Article
                3285
                10.1186/s12889-016-3285-5
                4955130
                27439981
                7332f49a-c635-4908-930c-669ca8b28fed
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 May 2016
                : 8 July 2016
                Funding
                Funded by: Caja Navarra Foundation, Spain
                Award ID: (22-2014)
                Award Recipient :
                Funded by: Institute for Culture and Society of the University of Navarra, Spain
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2016

                Public health
                hiv,voluntary counseling and testing (vct),negative test,sexual,behaviour,knowledge,cohort,africa

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