BMC Public Health Research article Promotion of couples' voluntary counselling and testing for HIV through influential networks in two African capital cities Susan Allen*1,2, Etienne Karita1, Elwyn Chomba1,3, David L Roth4, Joseph Telfair5, Isaac Zulu1, Leslie Clark6, Nzali Kancheya1, Martha Conkling1,2, Rob Stephenson2, Brigitte Bekan1, Katherine Kimbrell1,7, Steven Dunham1, Faith Henderson1,2, Moses Sinkala8, Michel Carael9 and Alan Haworth1,3,10 BioMed Central Open Access Address: 1The Rwanda-Zambia HIV Research Group, 1520 Clifton Road, Emory University, Atlanta, GA 30322, USA, 2Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA, 3University Teaching Hospital, Lusaka, Zambia, 4Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1530 3rd Ave S., Birmingham, AL 35294-0022, USA, 5Department of Public Health Education, University of North Carolina at Greensboro, 437 HHP Building, Greensboro, NC 27402-6170, USA, 6Department of Pediatrics, School of Medicine, University of Southern California, 4650 Sunset Blvd., CHLA MS 30, Los Angeles, CA 90027, USA, 7School of Medicine, Harvard University, 25 Shattuck Street, Boston, MA 02115, USA, 8Lusaka Urban District Health Management Team, Makishi Road, PO Box 50827, Lusaka, Zambia, 9Monitoring and Evaluation Unit, UNAIDS, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland and 10Counseling Services Unit, Ministry of Health, PO Box 30205, Lusaka, Zambia Email: Susan Allen* - sallen5@sph.emory.edu; Etienne Karita - ekarita@psfiavi.rw; Elwyn Chomba - echomba@zamnet.zm; David L Roth - droth@uab.edu; Joseph Telfair - j_telfai@uncg.edu; Isaac Zulu - zuluisaac@yahoo.com; Leslie Clark - lclark@chla.usc.edu; Nzali Kancheya - kancheyanzali@lycos.com; Martha Conkling - mconkl2@sph.emory.edu; Rob Stephenson - rbsteph@sph.emory.edu; Brigitte Bekan - bbekan@yahoo.fr; Katherine Kimbrell - katherine_kimbrell@yahoo.com; Steven Dunham - dunhamsteven@yahoo.com; Faith Henderson - FaithHenderson@rzhrg.org; Moses Sinkala - msinkala@lycos.com; Michel Carael - caraelm@yahoo.fr; Alan Haworth - haworth@zamnet.zm * Corresponding author Published: 11 December 2007 BMC Public Health 2007, 7:349 doi:10.1186/1471-2458-7-349 This article is available from: http://www.biomedcentral.com/1471-2458/7/349 Received: 24 April 2007 Accepted: 11 December 2007 © 2007 Allen et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract analysis. Background: Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples' Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. We present our experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia. Methods: Influence Network Agents (INAs) from the health, religious, non-governmental, and private sectors were trained to invite couples for CVCT. Predictors of successful promotion were identified using a multi-level hierarchical Results: In 4 months, 9,900 invitations were distributed by 61 INAs, with 1,411 (14.3%) couples requesting CVCT. INAs in Rwanda distributed fewer invitations (2,680 vs. 7,220) and had higher response rates (26.9% vs. 9.6%), than INAs in Zambia. Context of the invitation event, including a discreet location such as the INA's home (OR 3.3–3.4), delivery of the invitation to both partners in the couple (OR 1.6–1.7) or to someone known to the INA (OR 1.7–1.8), and use of public endorsement (OR 1.7–1.8) were stronger predictors of success than INA or couple-level characteristics. Conclusion: Predictors of successful CVCT promotion included strategies that can be easily implemented in Africa. As new resources become available for Africans with HIV, CVCT should be broadly implemented as a point of entry for prevention, care and support. Page 1 of 10 (page number not for citation purposes)