1. Evolution of Couples Voluntary Counseling and Testing for HIV in Rwanda Etienne Karita, Sabin Nsanzimana, Felix Ndagije, Kristin Wall, Jeannine Mukamuyango, Placidie Mugwaneza, Eric Remera, Pratima Raghunathan, Rachel Parker, Amanda Tichacek, Susan Allen Rwanda Zambia HIV Research Group Emory University 20th International AIDS Conference (AIDS 2014)

2. Introduction Global AIDS Epidemic in 2012 35.3 million adults and children 70% reside in sub-Saharan Africa Couples Voluntary Counseling and Testing (CVCT) Effective Intervention for Prevention of heterosexual HIV Transmission Prevention of mother-to-child transmission Methods 2003 Project San Francisco and Rwandan Ministry of Health jointly endorsed CVCT services in Rwanda Promotion of CVCT service in communities Influential network agents (INA) and community health workers

3. Results CVCT at PSF centers (2003-2008) – Total couples tested 41,582 (78% Cohabiting) – Proportion of couples with one or both partners HIV+ 20% of cohabiting couples 14% of non-cohabiting couples – Among HIV+ women, Proportion in a discordant partnership Cohabiting couples 44% Non cohabiting couples 78 % Public Antenatal clinics (2003-2012) – Total couples tested nationwide 1.6 million – Proportion of pregnant women tested with partners 2003 16%, increasing steadily until 2009-2012 84%

4. Conclusion Rwanda first country to establish – Routine CVCT in antenatal care Important factors for success of Intervention – Establishment of CVCT as social norm – Involvement of community health workers and local leaders – Commitment and motivation of health care providers through the institutionalization of a performance-based approach in health care facilities – Strong political support at all levels Model replicable in other settings

5. Conflict of Interest Disclosure: I have no potential or actual conflicts of interest due to financial or personal relationships that might be perceived to cause bias.