CVCT

Before I begin my own work at Projet San Francisco (PSF), I will complete rotations through each of the departments and aspects of the project. I began today with the Couples’ Voluntary Counseling and Testing (CVCT) centers.

PSF operates three CVCT centers that are spread throughout Kigali. When couples arrive at one of the three PSF sites in town for CVCT, they first go through verification to ensure that they are truly a cohabiting couple (a later requirement for participation in our studies). They then participate in a group session, which I observed at Gitega (the CVCT site located at our main site), where ten couples were present for testing. The group first participates in an information session that covers topics including background information on PSF, the differences between HIV and AIDS, possible test results (both partners positive, both negative, one positive and one negative), how to prevent transmission (including how to use a condom), and various other topics such as prevention of mother to child transmission (PMTCT) and sexually transmitted infections. After each topic is presented in a video, a senior nurse counselor highlights important points and answers any questions. The group then watches a video about informed consent. Since we are a research institution, all couples must sign a document that states their consent to participate before they are even counseled.

After the group sessions, each couple is seen separately for pre-test counseling. For this session, I went to the PSF site at Gatsata, which is about a 15 minute drive away. I sat in on two pre-test counseling sessions, during which a nurse counselor makes sure the couple understands testing and is prepared for whatever results they may receive. Although these sessions (like all others) are conducted in Kinyarwanda (the local language here), I could tell that the nurse counselor is very thorough and very sensitive to the couples. After pre-test counseling, the couples are sent to the lab, where blood is drawn for testing. They then return to the group room, where they receive lunch while waiting for their results. I joined the lab technicians to centrifuge samples and run rapid tests for HIV and syphilis. We then prepared the results for each couple, sealing each person’s results in a separate envelope. After lunch, the couples return to nurse counselors for post-test counseling and to receive their results. Before giving results to the couple, the nurse counselor was careful to make sure that couples again understood and were prepared for the results they were about to receive. Then each individual was handed his or her envelope, which he/she opened for his/her results. Both couples I joined for CVCT were concordant negative, meaning both partners received negative results from their HIV tests. And both were so thankful – one couple even jumped to their feet and hugged the nurse counselor and I after reading their results. I was thankful too; it’s going to be really difficult to be in the room with a couple when at least one partner is positive. The nurse counselor again made sure the couple understood the results after reading them and, for the two discordant negative couples, discussed the importance of fidelity in order to maintain their negative status.

After all the couples were counseled and dismissed, I joined the nurse counselors and lab technicians for lunch. We had a truly hearty lunch of rice, beans, meat (I couldn’t tell you what kind, but it was good), and cassava. I don’t know if I can eat that large and hearty of a meal every day, but it was a good introduction to Rwandan cuisine.

At the end of the day, I left the site and stopped by the third PSF site at Kicukiro to check on the day’s results there.

It was a good first day, but very busy and very full. There's a lot of work to be done.