Rapid expansion of Couples Voluntary Counseling and Testing for HIV in Zambia's Copperbelt Province

Given that 70% of new HIV infections in Zambia are acquired from cohabiting partners in discordant couples, discordant couples identified through Couples' Voluntary Counseling and Testing for HIV (CVCT) represent a significant, cost-effective opportunity to prevent new HIV infections. In August 2009, the Zambia Emory HIV Research Project (ZEHRP) began expansion of CVCT in Zambia's Copperbelt Province. ZEHRP is assisting government clinics in implementing weekend CVCT; and, integrating CVCT programming into existing PMTCT, VCT, ART, and blood screening activities. Over 2.5 years, ZEHRP will establish in 60 new government and mine clinics and 56,000 couples will be tested. Since the program's beginning, 1,266 couples have completed CVCT. Of the couples tested, 62% were concordant negative (M-F-), 21% concordant positive (M+F+), and 16% discordant (53% M-F+, 46% M+F-). Of the discordant couples (n=200), 70% of females and 44% of males had previously received HIV testing; however, only 12% had ever tested as a couple. Assuming all HIV+ Africans could be identified and treated, a ‘test and treat' prevention approach would require that the US double its Foreign Service budget and allocate it all to ART in Africa. In today's economic climate, the chances of this are vanishingly small. Although the 30 months of this project will fall in the most expensive, early stages of couples' testing expansion due to advocacy, training, and promotional costs, the cost per infection averted will be $439; a significant cost-savings compared to the cost of $5943/year for preventing one transmission in a discordant couple using ART.