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

Objective: : To investigate whether community engagement (participation in grassroots organisations) contributed to increases in HIV testing in Zimbabwe. Methods: : Prospective data on membership of local community organisations (e.g. women'sgroups 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 engagementon uptake of servicesduringthe follow-upperiod were measured using logistic regression to adjust for observed confounding factors. Results: : 16% of men and 47% of women were consistent members of community organisations; 58% and 35% of these peoplediscussed HIV in their meetings and were members of externally-sponsored organisations, respectively. Fewer men (10.1%) than women (32.4%) took up HTC during follow-up (aOR = 4.08, 95% CI 3.43-4.86, p < 0.001). HTC uptake was higher for members ofcommunity organisationsthan for non-members: 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 organisations showed a non-significant 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 organisations that discussed HIV and when external sponsorship was absent. Conclusion: : Grassroots organisations contributed to increased uptake of HTC services in eastern Zimbabwe in the mid-2000 s. Partnerships with these organisationscould harness community support for the further increases in HIV testing needed insub-Saharan Africa.