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Behaviour change in clients of health centre-based voluntary HIV counselling and testing services in Kenya

¹ Camden Primary Care Trust and University College, London, UK
² Center for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
³ National Institute of Public Health, Cuernavaca, Mexico
⁴ United Nations Children’s Fund, Kenya
⁵ Imperial College, London, UK

Correspondence to:
Correspondence to:
Dr G Arthur
Camden Primary Care Trust, The Mortimer Market Centre, London WC1E, UK; gilly.arthur{at}camdenpct.nhs.uk

Objective: To explore behaviour change, baseline risk behaviour, perception of risk, HIV disclosure and life events in health centre-based voluntary counselling and testing (VCT) clients.

Design and setting: Single-arm prospective cohort with before–after design at three (one urban and two rural) government health centres in Kenya; study duration 2 years, 1999–2001.

Subjects: Consecutive eligible adult clients.

Main outcome measures: Numbers of sexual partners, partner type, condom use, reported symptoms of sexually transmitted infection, HIV disclosure and life events.

Results: High rates of enrolment and follow-up provided a demographically representative sample of 401 clients with mean time to follow-up of 7.5 months. Baseline indicators showed that clients were at higher risk than the general population, but reported a poor perception of risk. Clients with multiple partners showed a significant reduction of sexual partners at follow-up (16% to 6%; p<0.001), and numbers reporting symptoms of sexually transmitted infection decreased significantly also (from 40% to 15%; p<0.001). Condom use improved from a low baseline. Low rates of disclosure (55%) were reported by HIV-positive clients. Overall, no changes in rates of life events were seen.

Conclusion: This study suggests that significant prevention gains can be recorded in clients receiving health centre-based VCT services in Africa. Prevention issues should be considered when refining counselling and testing policies for expanding treatment programmes.

Abbreviations: DCT, diagnostic counselling and testing; VCT, voluntary counselling and testing; STI, sexually transmitted infection

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