Grassroots community organizations’ contribution to the scale-up of HIV testing and counselling services in Zimbabwe

OBJECTIVE To investigate whether community engagement (participation in grassroots organizations) contributed to increases in HIV testing in Zimbabwe. METHODS Prospective data on membership of local community organizations (e.g. women's groups and burial societies) and uptake of HIV testing and counselling (HTC) and prevention-of-mother-to-child transmission (PMTCT) services were collected from 5260 adults interviewed in two consecutive rounds of a general-population cohort survey in eastern Zimbabwe between 2003 and 2008. The effects of community engagement on uptake of services during the follow-up period were measured using logistic regression to adjust for observed confounding factors. RESULTS Sixteen percent of men and 47% of women were consistent members of community organizations; 58 and 35% of these people discussed HIV in their meetings and were members of externally sponsored organizations, respectively. Fewer men (10.1%) than women (32.4%) took up HTC during follow-up [adjusted odds ratio (aOR)=4.08, 95% confidence interval (CI) 3.43-4.86, P<0.001]. HTC uptake was higher for members of community organizations than for nonmembers: men, 15.0 versus 9.2% (1.67, 1.15-2.43, P=0.007); women, 35.6 versus 29.6% (1.26, 1.06-1.49, P=0.008). Membership of community organizations showed a nonsignificant association with PMTCT uptake amongst recently pregnant women (42.3 versus 34.2%; 1.30, 0.94-1.78, P=0.1). The most consistent positive associations between community participation and HTC and PMTCT uptake were found in organizations that discussed HIV and when external sponsorship was absent. CONCLUSION Grassroots organizations contributed to increased uptake of HTC services in eastern Zimbabwe in the mid-2000s. Partnerships with these organizations could harness community support for the further increases in HIV testing needed in sub-Saharan Africa.