This is a randomized controlled trial to examine the efficacy of an integrated model of HIV post-test support for women attending the King Edward VIII Hospital (KEH) antenatal care (ANC) clinic in Durban, South Africa. The rates of HIV infection among pregnant women in South Africa are among the highest in the world. The government provides all women with access to antiretrovirals (ARV) during pregnancy to reduce transmission of HIV infection to infants. However, there is a growing recognition that the uptake and adherence to PMTCT programs could be improved and that the current programs largely overlook the enormous psychosocial challenges associated with testing pregnant women. The proposed intervention is designed to tailor VCT for the ANC setting and provide a continuum of psychosocial support through: (1) a health education video before HIV pre-test counseling;(2) HIV pre- and post-test counseling that prepares women for decisions related to HIV testing, HIV serostatus disclosure, infant feeding and ARV prophylaxis;(3) two additional post-test counseling sessions which coincide with 6 and 10-week postpartum visits and focus on infant health, sexual risk reduction, partner testing, and family planning and;(4) an active referral system to support groups run by an NGO affiliated with KEH. To accomplish this trial we will: (1) conduct ethnographic research to describe the determinants of key behaviors from the perspective of women and their male partners;(2) enroll and interview a cohort of 1,495 HIV-positive and HIV-negative participants to determine baseline biologic (Gonorrhea, Trichomonas vaginalis, Chlamydia), behavioral, and psychosocial characteristics;(3) randomize participants to standard VCT or standard VCT plus post-test support;(4) Follow participants 9-months post-partum to compare sexual risk (STI incidence, correct &consistent condom use, partner testing);factors associated with HIV mother to child transmission (acceptance of VCT and ARVs, infant feeding choices, family planning intention) and psychosocial outcomes (social support, emotional distress and partner violence) among participants who receive the VCT plus post-test support with participants who receive standard VCT. We hypothesize that the intervention will have a public health impact by expanding the preventive benefits of PMTCT programs while concurrently increasing the benefits and minimizing the psychosocial harms associated with VCT and HIV serostatus disclosure for women.
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