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Recruiting the social contacts of patients with STI for HIV screening in Lilongwe, Malawi: process evaluation and assessment of acceptability
  1. Nora E Rosenberg1,2,3,
  2. Christopher C Stanley1,
  3. Sarah E Rutstein3,4,
  4. Naomi Bonongwe1,
  5. Gift Kamanga1,4,
  6. Audrey Pettifor2,
  7. Clement Mapanje1,
  8. Francis Martinson1,3,
  9. Irving F Hoffman1,3,
  10. William C Miller2,3
  1. 1UNC Project, UNC Chapel Hill, Lilongwe, Malawi
  2. 2Department of Epidemiology, UNC Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3Department of Medicine, UNC Chapel Hill, Chapel Hill, North Carolina, USA
  4. 4Department of Health Policy and Management, UNC Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Nora E Rosenberg, University of North Carolina Project, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi; Nora_Rosenberg{at}


Objectives To explore acceptability of recruiting social contacts for HIV and sexually transmitted infection (STI) screening in Lilongwe, Malawi.

Methods In this observational study, three groups of ‘seed’ patients were enrolled: 45 HIV-infected patients with STI, 45 HIV-uninfected patients with STI and 45 community controls, who were also tested for HIV as part of the study. Each seed was given five coupons and asked to recruit up to five social contacts to the STI clinic. Seeds were told the programme for contacts would include HIV testing, STI screening and general health promotion. Seeds were asked to return after 1 month to report on the contact recruitment process. Seeds received $2 for each successfully recruited contact.

Results Eighty-nine seeds (66%) returned for 1-month follow-up with no difference between the three seed groups (p=0.9). Returning seeds reported distributing most of their coupons (mean=4.1) and discussing each feature of the programme with most contacts—HIV testing (90%), STI screening (87%) and health promotion (91%). Seeds reported discussing their own HIV status with most contacts (52%), with a lower proportion of HIV-infected seeds discussing their HIV status (22%) than HIV-uninfected seeds (81%) or community seeds (64%) (p<0.001). Contact recruitment did not vary with socioeconomic status.

Conclusions Most seeds distributed all coupons and reported describing all aspects of the programme to most contacts. Patients with STI are able to act as health promoters within their social networks and may be a critical link to increasing STI and HIV status awareness among high-risk groups.

  • HIV

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  • Handling editor Jackie A Cassell

  • Contributors GK, WCM, NER and AP conceptualised the study with guidance from IFH and FM. NER, SER, AP and GK developed data collection tools. GK, CM and NB oversaw study implementation. CS conducted all analyses under the guidance of NER. NB, NER and CS drafted the initial manuscript. All authors provided substantive edits to the manuscript and approved the final draft.

  • Funding This research was funded by a 2010 developmental grant from the University of North Carolina at Chapel Hill Center for AIDS Research (P30 AI50410) and NIAID (R01 AI083059, R01 AI114320). NER was supported by NIH HIV/STD training grant (T32 AI007001-34), UNC Hopkins Morehouse Tulane Fogarty Global Health Fellows Program (R25 TW009340) and National Institute of Mental Health (K99MH104154-01A1). SER is funded by the National Institutes of Health (F30 MH098731-01) and (T32 GM008719).

  • Competing interests None declared.

  • Ethics approval The study was approved by the National Health Sciences Research Commission in Malawi (#701) and the Institutional Review Board at the School of Medicine at the University of North Carolina, Chapel Hill (IRB # 09-2380). All seeds and contacts provided written informed consent to participate.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional data are available from the authors upon request.