Knowledge and Perceptions of Counselors Regarding Counselor Referrals for Care, Treatment and Potential Enrollment in Research Studies in Zambia

HIV sero-discordant couples represent a unique opportunity to research the effects of behavioral and biomedical interventions (to reduce disease progression in the infected member and HIV-transmission to the uninfected member) within the relationship dynamics of stable couples. Despite this, little is known about the referrals given to HIVsero-discordant couples in post-test counseling sessions, and only half of sero-discordant couples offered referrals come for care and treatment or screening for enrollment into research studies. The authors sought to examine the referral practices of test counselors as barriers to or facilitators of treatment and research referral uptake. This study is a formative evaluation of program operations that monitored how well referral protocol is being followed by Zambian test counselors working for the Zambia Emory HIV Research Group. Researchers interviewed 82% of all part-time counselors (n=54/66) and 63% of all full-time counselors (n=10/16) using a qualitative open-ended interview. Thematic analysis was used to illuminate main themes from the interviews. There was no single, uniformly applied definition of “standardized” referrals among test counselors working for the Zambia Emory HIV Research Group although commonly expressed criteria included the need to be candid about providing accurate information with the couple, actively encourage uptake of referrals, and proactively address the couples fears and stigmas. In order to ensure that discordant couples are receiving necessary care and treatment and referrals into research studies, program planners must be aware of the referral practices of their counselors and attempt to shape those in line with agency-established criteria for “standardized” referral.