Scaling up HIV voluntary counseling and testing in Africa: what can evaluation studies tell us about potential prevention impacts?

This study, published by Cornell University, explores the impact of voluntary counselling and testing (VCT) on risk behaviour in Africa by applying new questions and theoretical frameworks to existing evidence. The paper examines the claim that scaling up HIV VCT programmes in Africa will have major prevention benefits through reduction in risk behaviours. It also explores the claims that a policy of promoting "couples VCT" will be more successful than individual testing, and that VCT demand and prevention impacts will be improved where scaling up is accompanied by anti-retroviral therapy (ART).

While some important clues about expanded VCT programmes have emerged, findings show that existing VCT evaluation evidence is insufficient to predict behavioural outcomes. Consequently, new methods of evaluation are necessary and the merits of community - rather than individual - level VCT evaluations are outlined. The author explains that community evaluations would provide direct estimates of programme outcomes, and would establish VCT impacts beyond those who are directly treated. Future evaluations should therefore focus on community-level information as well as assessing the demand for and impact of VCT in contexts where ART is made available. [adapted from author]