Perceived acceptability of home-based couples voluntary HIV counseling and testing in Northern Tanzania.

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It is estimated that 5.6% of the Tanzanian population ages 15-49 are infected with HIV, but only 30% of adults have ever had an HIV test. Couples' testing has proven to increase testing coverage and introduce HIV prevention, but barriers include access to testing services and unequal gender dynamics in relationships. Innovative approaches are needed to address barriers to couple's testing and increase uptake of HIV testing. Using qualitative data collection methods, a formative study was conducted to assess the acceptability of a home-based couples counseling and testing (HBCCT) approach. Eligible study participants included married men and women, HIV-infected individuals, health care and home-based care providers, voluntary counseling and testing counselors, and community leaders. A total of 91 individuals participated in focus group discussions (FGDs) and in-depth interviews conducted between September 2009 and January 2010 in rural settings in Northern Tanzania. An HBCCT intervention appears to be broadly acceptable among participants. Benefits of HBCCT were identified in terms of access, confidentiality, and strengthening the relationship. Fears of negative consequences from knowing one's HIV status, including stigma, blame, physical abuse, or divorce, remain a concern and a potential barrier to the successful provision of the intervention. Lessons for implementation highlighted the importance of appointments for home visits, building relationships of confidence and trust between counselors and clients, and assessing and responding to a couple's readiness to undergo HIV testing. HBCCT should addresses HIV stigma, emphasize confidentiality, and improve communication skills for disclosure and decision-making among couples.





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Njau, B, MH Watt, J Ostermann, R Manongi and KJ Sikkema (2012). Perceived acceptability of home-based couples voluntary HIV counseling and testing in Northern Tanzania. AIDS Care, 24(4). pp. 413–419. 10.1080/09540121.2011.608796 Retrieved from

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Melissa Watt

Adjunct Associate Professor of Global Health

Dr. Watt's research focuses on understanding and addressing gender-specific health issues in sub-Saharan Africa, with specific attention to HIV, substance use and mental health. In Tanzania, she currently leads an implementation science study aimed at improving access to long-term antiretroviral therapy for pregnant women with HIV. In South Africa, she is collaborating with Dr. Kathleen Sikkema on a study to support HIV care engagement in the context of sexual trauma. In Ghana, she is supporting a team of DGHI graduate students in Global Health to examine the impact of community health workers on the uptake of family planning. Completed research includes the development and evaluation of mental health treatment for women with obstetric fistula in Tanzania, prevention of alcohol-exposed pregnancies in South Africa, and understanding HIV risk behaviors among individuals who use methamphetamine in South Africa.

Dr. Watt directs the Master of Science in Global Health at DGHI and serves as the Associate Director for the Social and Behavioral Sciences Core of the Duke Center for AIDS Research. She has a Ph.D. in Health Behavior from the University of North Carolina, and an M.A. in Gender and Development from the University of Sussex in the U.K.

Jan Ostermann

Adjunct Associate Professor of Global Health

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