Evolution of couples voluntary counseling and testing for HIV in Rwanda: From research to public health practice.

Background: Couples’ Voluntary HIV Counseling and Testing (CVCT) is a WHO-recommended intervention for prevention of heterosexual HIV transmission which very few African couples have received. We report the successful nationwide implementation of CVCT in Rwanda. Methods: From 1988-1994 pregnant and post-partum women were tested for HIV and requested testing for their husbands. Partner testing was associated with more condom use and lower HIV and STI rates particularly among HIV discordant couples. After the 1994 genocide the research team continued to refine CVCT procedures in Zambia. These were re-introduced to Rwanda in 2001 and continually tested and improved. In 2003 the Government of Rwanda (GoR) established targets for partner testing among pregnant women with the proportion rising from 16% in 2003 to 84% in 2008 as the PMTCT program expanded to >400 clinics. In 2009 the GoR adopted joint post-test counseling procedures and in 2010 a quarterly follow-up program was established in government clinics with training and technical assistance. An estimated 80 - 90% of Rwandan couples have now been jointly counseled and tested resulting in prevention of >70% of new HIV infections. Conclusion: Rwanda is the first African country to have established CVCT as standard of care in ANC. More than 20 countries have sent providers to Rwanda for CVCT training. To duplicate Rwanda’s success training and technical assistance must be part of a coordinated effort to set national targets timelines indicators and budgets. Governments bilateral and multilateral funding agencies must jointly prioritize CVCT for prevention of new HIV infections. Copyright: 2016 Wolters Kluwer Health Inc.