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Voluntary Counseling and Testing: An
Effective Strategy for Preventing HIV/AIDS Transmission
(December 2001)
Thomas J. Coates et al. 2000. "The Voluntary HIV-1 Counseling and Testing Efficacy Study: A Randomized Controlled Trial in Three Developing Countries." University of California, AIDS Research Institute, Center for AIDS Prevention Studies: San Francisco.
Introduction
Many healthcare providers in developing countries believe that voluntary counseling and testing (VCT) has a minimal role in preventing HIV/AIDS. Many providers also believe that VCT should only be available if it is possible to provide long-term antiretroviral therapy.
To measure the efficacy of HIV VCT, Thomas J. Coates and his team from the University of California in San Francisco conducted a randomized controlled trial in three developing countries-Kenya, Tanzania and Trinidad. In all of these countries access to antiretrovirals and other expensive medications is a dream yet to be realized.
Methodology
The study was implemented at freestanding clinics in Nairobi, Dar es Salaam and Port-of-Spain. A total of 3120 individuals and 586 couples were recruited. Baseline visits included a survey, collection of urine samples and randomization of participants to the VCT (study group) or the Health Information and Education (HI) (control group). The study group received pretest counseling, blood sample testing for HIV-1, and post-test counseling, whereas the HI group received a health education session. Both groups received 25 condoms with instructions on how to use them. Two followup visits were provided. At the first followup visit, participants were given a behavioral interview, STD diagnosis and treatment. All participants, including those in the HI group, were offered HIV VCT. The second followup visit included a repeat behavioral interview and STD screening. At the second followup visit, HIV VCT was offered to those who had refused it at the first followup visit.
Major Findings
- VCT for HIV-1 reduces unprotected intercourse among individuals and couples. Reduction of unprotected intercourse was significantly greater among those who tested positive for HIV-1.
- Rates of negative life events (i.e., breakup of a relationship and physical abuse) were rare among those who disclosed that they had HIV. And although rates of physical abuse were higher for HIV-infected persons, they were not so high as to discourage the use of HIV VCT.
- HIV-1 VCT is a highly cost-effective preventive intervention in developing country settings, comparable to other proven prevention strategies such as enhanced sexually transmitted disease (STD) services and universal provision of nevirapine for pregnant women in high prevalence settings. The cost per HIV-1 infection averted was $249 in Kenya and $346 in Tanzania. The cost per disability adjusted life year saved was $12.77 in Kenya and $17.78 in Tanzania.
Conclusion
This study reinforces the benefits and cost-effectiveness of HIV-1 VCT as part of a comprehensive package of prevention strategies for the developing world.
To view the complete article, visit http://www.caps.ucsf.edu/publications/VCTS2C.pdf.