abstract background methods results results conclusion
The Role of Technical Assistance in Establishing Couples’ Testing as Standard of Care for HIV Vaccine Trial Participants
Appiagyei, A., MPH1; Mwaanga, A., MSc1; Sinabambenye, R., RN2; Hoagland, A., MPH (c) 3; Gudo, E.1; Banda, H.1; Mulenga, M.1; Mutumwinka, B.2; Ahmed, N., MPH1; Siangonya, B.1; Inambao, M., MD MPH1; Karita, E., MD MPH2; Kilembe, 1 4
W., MD MSc ; Allen, S., MD MPH
ABSTRACT
1. Zambia Emory HIV Research Project, Lusaka, Zambia, 2. Project San Francisco, Kigali, Rwanda; 3. Emory University Rollins School of Public Health, Atlanta, GA, U.S.A.;
4. Emory University School of Medicine, Atlanta, GA, U.S.A.
WHO guidelines recommend couples voluntary HIV counseling and testing (CVCT). From 2009-2011, RZHRG provided Technical Assistance (TA) to over 1,785 people from 146 partners in 18 countries. Available data from 2012 indicated significant increases in provision and uptake of CVCT in 12 of 18 recipient countries either for research or programmatic purposes. Increased uptake of CVCT led to increased identification of discordant couples. As yet, only two countries offer follow up for discordant couples in government facilities. Establishing CVCT as the standard of care in countries across the region has significant implications for HIV vaccine trials.
BACKGROUND
RESULTS
RESULTS
Progress in CVCT in select RZHRG COE recipient countries
Country
transmission [1,2]. Couples’ Voluntary HIV Counseling and Testing (CVCT) is associated with a two-thirds reduction in HIV transmission among HIV serodiscordant couples [1,2]. WHO guidelines recommend CVCT [3]. Through CVCT, couples experience mutual disclosure of HIV results and receive targeted counseling which affects sexual risk behaviors and hence vaccine trial outcomes. CVCT must be provided as standard of care for vaccine trial participants across countries and sites.
wishing to implement CVCT through their Center of Excellence (COE) program funded by the Centers for Disease Control and Prevention. RZHRG’s sites each offer uniquely different training sites for partners interested
Ghana
Study tour of RZHRG Rwanda and Zambia sites (2011) CVCT service provider training (2011)
Swaziland
From 2009-2011, RZHRG provided TA to over 1,785 people from 146 partners in 18 countries. Figure 1 illustrates the range of TA activities provided to countries and partners. Available data from 2012 indicated significant
increases in provision and uptake of CVCT in 12 of 18 recipient countries either for research or programmatic
needs. The RZHRG work plan places significant focus on the training of key country staff (including advocates, promotions managers, counselors, laboratory staff, and data managers) on the best way to integrate and sustain the management of CVCT programming in the context of existing VCT activities.
METHODS International TA events from 2009-2012 are described. TA events were classified as high-level advocacy, training for service providers and promotional agents, as well as training of trainers. These TA events occur through structured site visits. First, countries or partners interested in implementing CVCT programs have the opportunity to visit one of the three RZHRG sites to get “on-the-ground” training. Kigali, Rwanda, Lusaka and Copperbelt, Zambia each offer venues through which visiting professionals can learn the steps necessary to launch and sustain a successful CVCT program. After completing a site visit the COE attendees return to their home countries
follow up for discordant couples in government facilities (Rwanda and Zambia). Workshops held in Rwanda and Zambia in Nov-Dec 2012 attracted participants from 23 countries, confirming growing interest in CVCT.
The TA events are structured to illustrate the importance of CVCT programs and data collection. Monitoring and evaluation activities are also presented to illustrate country-adapted CVCT models, as well as changes in uptake of
Tanzania
FIGURE 1. Technical Assistance Center of Excellence Activity by Activity Type (N=50)
Technical Assistance Visit, 20
Advocacy Workshop/ Conference, 13
CVCT Training, 12
Interest generated through technical assistance and training provided from 2009-2010 paved the way for the development of a five-year national CVCT strategy and implementation plan, with accompanied changes to national HIV counseling and testing guidelines and funding Tested 468 couples in twelve months in the Western Region, where couples testing had never been provided. This represented an uptake of 46% among couples attending existing pregnancy schools.
CVCT Service Provider training (2009) Study tour of RZHRG Rwanda sites (2010) CVCT service provider training curriculum revision (2011) CVCT service provider training and training-of trainers (2011)
In 2013, the government of Swaziland will be leading the training of 250 service providers in CHCT. Interest generated through technical assistance and training from 2009-2011 has facilitated advocacy for the development of a national CVCT strategy.
CVCT needs assessment (2009) Study tour of RZHRG Rwanda and Zambia sites (2010) Adaptation of CVCT-male involvement service provider curriculum (2011) Development of CVCT sensitization guidelines and IEC materials (2011) CVCT/Male involvement service provider training (2011)
CVCT has become a key issue on the national agenda for Tanzania. In 2012, the President and First Lady of Tanzania received couples testing services. Ten of the twenty-six regions of Tanzania have been selected for intensive implementation of CVCT. Sites within these regions are planned to serve as training centers for future CVCT endeavors in Tanzania and in the region.
Through TA from an organization with experience in CVCT for vaccine trials and routine health services, recipient countries were able to acquire a multitude of skills which enabled them to more effectively implement CVCT. Countries with capacity to provide quality CVCT services should be considered in site selection for future vaccine
CVCT Promotions Training, 1
trials.
REFERENCES
1. FIGURE 2. Technical Assistance Activity by Activity Type and Activity Location (N=50)
Host Country Site Activity 6
RZHRG Site Activity 14
8
5
13
12
0
12
CVCT Promotions Training
1
0
1
COE Technical Assistance Total
2 29
2 21
4 50
Technical Assistance Visit Advocacy Workshop/ Conference CVCT Training
Noted Successes in CVCT
CONCLUSION COE Technical Assistance, 4
prepared for their CVCT implementation. RZHRG offers continued trainings on site to allow participants to learn in the context of their home countries.
Increased uptake of CVCT led to increased identification of discordant couples. As yet, only two countries offer
in establishing or expanding their CVCT programs. Trainings are tailored to each country or partner’s specific
CVCT and subsequent identification of discordant couples.
Study tour of RZHRG Zambia sites (2009) CVCT promotions training (2010)
purposes. These include:
The Rwanda Zambia HIV Research Group (RZHRG) provides technical assistance (TA) to countries and partners
TA is useful in ensuring that CVCT services are effectively adapted and implemented across the region.
Botswana
Representative from Ethiopia Federal Ministry of Health sharing progress in CVCT in Ethiopia, 2002 - 2012
Most African adults are in a cohabiting sexual union and these couples represent the largest risk group for HIV
Technical Assistance/Training Provided
Total 20
2.
3.
Trask, S.A., et al., Molecular epidemiology of human immunodeficiency virus type 1 transmission in a heterosexual cohort of discordant couples in Zambia. J Virol, 2002. 76(1): p. 397-405.
Allen, S., et al., Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS, 2003. 17(5): p. 733-40.
World Health Organization., Guidance on Couples HIV Testing and Counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: Recommendations for a public health approach. 2012: Geneva, Switzerland.
Appiagyei, A., MPH1; Mwaanga, A., MSc1; Sinabambenye, R., RN2; Hoagland, A., MPH (c) 3; Gudo, E.1; Banda, H.1; Mulenga, M.1; Mutumwinka, B.2; Ahmed, N., MPH1; Siangonya, B.1; Inambao, M., MD MPH1; Karita, E., MD MPH2; Kilembe, 1 4
W., MD MSc ; Allen, S., MD MPH
ABSTRACT
1. Zambia Emory HIV Research Project, Lusaka, Zambia, 2. Project San Francisco, Kigali, Rwanda; 3. Emory University Rollins School of Public Health, Atlanta, GA, U.S.A.;
4. Emory University School of Medicine, Atlanta, GA, U.S.A.
WHO guidelines recommend couples voluntary HIV counseling and testing (CVCT). From 2009-2011, RZHRG provided Technical Assistance (TA) to over 1,785 people from 146 partners in 18 countries. Available data from 2012 indicated significant increases in provision and uptake of CVCT in 12 of 18 recipient countries either for research or programmatic purposes. Increased uptake of CVCT led to increased identification of discordant couples. As yet, only two countries offer follow up for discordant couples in government facilities. Establishing CVCT as the standard of care in countries across the region has significant implications for HIV vaccine trials.
BACKGROUND
RESULTS
RESULTS
Progress in CVCT in select RZHRG COE recipient countries
Country
transmission [1,2]. Couples’ Voluntary HIV Counseling and Testing (CVCT) is associated with a two-thirds reduction in HIV transmission among HIV serodiscordant couples [1,2]. WHO guidelines recommend CVCT [3]. Through CVCT, couples experience mutual disclosure of HIV results and receive targeted counseling which affects sexual risk behaviors and hence vaccine trial outcomes. CVCT must be provided as standard of care for vaccine trial participants across countries and sites.
wishing to implement CVCT through their Center of Excellence (COE) program funded by the Centers for Disease Control and Prevention. RZHRG’s sites each offer uniquely different training sites for partners interested
Ghana
Study tour of RZHRG Rwanda and Zambia sites (2011) CVCT service provider training (2011)
Swaziland
From 2009-2011, RZHRG provided TA to over 1,785 people from 146 partners in 18 countries. Figure 1 illustrates the range of TA activities provided to countries and partners. Available data from 2012 indicated significant
increases in provision and uptake of CVCT in 12 of 18 recipient countries either for research or programmatic
needs. The RZHRG work plan places significant focus on the training of key country staff (including advocates, promotions managers, counselors, laboratory staff, and data managers) on the best way to integrate and sustain the management of CVCT programming in the context of existing VCT activities.
METHODS International TA events from 2009-2012 are described. TA events were classified as high-level advocacy, training for service providers and promotional agents, as well as training of trainers. These TA events occur through structured site visits. First, countries or partners interested in implementing CVCT programs have the opportunity to visit one of the three RZHRG sites to get “on-the-ground” training. Kigali, Rwanda, Lusaka and Copperbelt, Zambia each offer venues through which visiting professionals can learn the steps necessary to launch and sustain a successful CVCT program. After completing a site visit the COE attendees return to their home countries
follow up for discordant couples in government facilities (Rwanda and Zambia). Workshops held in Rwanda and Zambia in Nov-Dec 2012 attracted participants from 23 countries, confirming growing interest in CVCT.
The TA events are structured to illustrate the importance of CVCT programs and data collection. Monitoring and evaluation activities are also presented to illustrate country-adapted CVCT models, as well as changes in uptake of
Tanzania
FIGURE 1. Technical Assistance Center of Excellence Activity by Activity Type (N=50)
Technical Assistance Visit, 20
Advocacy Workshop/ Conference, 13
CVCT Training, 12
Interest generated through technical assistance and training provided from 2009-2010 paved the way for the development of a five-year national CVCT strategy and implementation plan, with accompanied changes to national HIV counseling and testing guidelines and funding Tested 468 couples in twelve months in the Western Region, where couples testing had never been provided. This represented an uptake of 46% among couples attending existing pregnancy schools.
CVCT Service Provider training (2009) Study tour of RZHRG Rwanda sites (2010) CVCT service provider training curriculum revision (2011) CVCT service provider training and training-of trainers (2011)
In 2013, the government of Swaziland will be leading the training of 250 service providers in CHCT. Interest generated through technical assistance and training from 2009-2011 has facilitated advocacy for the development of a national CVCT strategy.
CVCT needs assessment (2009) Study tour of RZHRG Rwanda and Zambia sites (2010) Adaptation of CVCT-male involvement service provider curriculum (2011) Development of CVCT sensitization guidelines and IEC materials (2011) CVCT/Male involvement service provider training (2011)
CVCT has become a key issue on the national agenda for Tanzania. In 2012, the President and First Lady of Tanzania received couples testing services. Ten of the twenty-six regions of Tanzania have been selected for intensive implementation of CVCT. Sites within these regions are planned to serve as training centers for future CVCT endeavors in Tanzania and in the region.
Through TA from an organization with experience in CVCT for vaccine trials and routine health services, recipient countries were able to acquire a multitude of skills which enabled them to more effectively implement CVCT. Countries with capacity to provide quality CVCT services should be considered in site selection for future vaccine
CVCT Promotions Training, 1
trials.
REFERENCES
1. FIGURE 2. Technical Assistance Activity by Activity Type and Activity Location (N=50)
Host Country Site Activity 6
RZHRG Site Activity 14
8
5
13
12
0
12
CVCT Promotions Training
1
0
1
COE Technical Assistance Total
2 29
2 21
4 50
Technical Assistance Visit Advocacy Workshop/ Conference CVCT Training
Noted Successes in CVCT
CONCLUSION COE Technical Assistance, 4
prepared for their CVCT implementation. RZHRG offers continued trainings on site to allow participants to learn in the context of their home countries.
Increased uptake of CVCT led to increased identification of discordant couples. As yet, only two countries offer
in establishing or expanding their CVCT programs. Trainings are tailored to each country or partner’s specific
CVCT and subsequent identification of discordant couples.
Study tour of RZHRG Zambia sites (2009) CVCT promotions training (2010)
purposes. These include:
The Rwanda Zambia HIV Research Group (RZHRG) provides technical assistance (TA) to countries and partners
TA is useful in ensuring that CVCT services are effectively adapted and implemented across the region.
Botswana
Representative from Ethiopia Federal Ministry of Health sharing progress in CVCT in Ethiopia, 2002 - 2012
Most African adults are in a cohabiting sexual union and these couples represent the largest risk group for HIV
Technical Assistance/Training Provided
Total 20
2.
3.
Trask, S.A., et al., Molecular epidemiology of human immunodeficiency virus type 1 transmission in a heterosexual cohort of discordant couples in Zambia. J Virol, 2002. 76(1): p. 397-405.
Allen, S., et al., Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS, 2003. 17(5): p. 733-40.
World Health Organization., Guidance on Couples HIV Testing and Counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: Recommendations for a public health approach. 2012: Geneva, Switzerland.
