P06-04. Using referrals from government health centers to expand an HIV discordant couple cohort in Lusaka, Zambia in preparation for vaccine efficacy trials

Background

The Zambia Emory HIV Research Project (ZEHRP) uses Couples HIV Counselling and Testing (CHCT) centers to recruit a large cohort of discordant couples in preparation for HIV prevention and vaccine trials. In 2008–2009, the project shifted from operating 3 private CHCT centers to supporting CHCT at government health centers throughout Lusaka, casting a wider net for study recruitment while building a sustainable service.

Methods

ZEHRP partnered with the Ministry of Health (MOH) and the Lusaka Urban District Health Management Team (LUDHMT) to introduce CHCT into Lusaka government clinics. ZEHRP assessed government clinics' ability and willingness to support CHCT. ZEHRP partnered with clinics that agreed to contribute space, staff time, and volunteer promoters. ZEHRP trained counsellors and promoters. MOH provided rapid test kits. ZEHRP provided other materials, overtime wages for clinic staff, and ZEHRP staff time. CHCT is conducted Saturday and Sunday when clinics are less crowded and men are more likely to attend with their wives. HIV-discordant couples are given appointments at ZEHRP's clinic; ZEHRP provides transport from government clinics.

Results

Collaboration permitted rapid expansion, making CHCT accessible to residents throughout Lusaka. As of May 2009, 11 Lusaka government clinics offered weekend CHCT (1 opened in 2006, 7 in 2008, 3 in early 2009) and referred discordant couples to ZEHRP's clinic for further screening and enrollment. From April 2008 – March 2009, 2754 couples tested at weekend clinics; 435 discordant couples were referred to ZEHRP, 249(57%) came and 174 (40%) enrolled into the cohort study. 75 couples were ineligible after further screening for reasons such as CD4<200, couple not meeting age or cohabitation requirements, and index partner on ARVs.

Conclusion

Cohort recruitment can be achieved through referrals from services offered at government health centers. This method of recruitment may prove to be cost-effective and sustainable for long-term study recruitment