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Results of a couples-based randomized controlled trial aimed to increase testing for HIV

Darbes, Lynae A., Ph.D.1; Mcgrath, Nuala M., Ph.D.2; Hosegood, Victoria, Ph.D.3; Johnson, Mallory O., Ph.D.4; Fritz, Katherine, Ph.D.5; Ngubane, Thulani, MTH6; Van Rooyen, Heidi, Ph.D.7

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 30, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000001948
Original Article: PDF Only

Background: Although couples-based HIV testing and counseling (CHTC) is effective for facilitating mutual disclosure and linkage to HIV care, uptake remains low. Using a randomized controlled design, we tested the efficacy of a behavioral couples-based intervention aimed to increase CHTC.

Setting: The Vulindlela district of KwaZulu-Natal, South Africa.

Methods: Couples were recruited from the community (e.g., markets, community events). Couples were excluded if mutual HIV serostatus disclosure had occurred. Both partners had to report being each other’s primary partner and relationship length was at least six months. Assessments occurred at baseline, and 3-, 6-, and 9-months post-intervention.

Eligible couples attended a group session (3-4 hours) after which randomization occurred. Intervention couples additionally received: one couples-based group session followed by four couples’ counseling sessions (1-2 hours). Intervention topics included communication skills, intimate partner violence, and HIV prevention. Our primary outcomes were CHTC and sexual risk behaviour.

Results: Overall, 334 couples were enrolled. Intervention couples were significantly more likely to have participated in CHTC (42% v. 12% [p < 0.001]). Additionally, their time to participate in CHTC was significantly shorter (logrank p < 0.0001) (N=332 couples). By group, 59% of those who tested HIV-positive in intervention and 40% of those who tested in control were new HIV diagnoses (p = 0.18). There were no group differences in unprotected sex.

Conclusion: Our intervention improved CHTC uptake—a vehicle for mutual serostatus disclosure and entrée into HIV treatment, both of which exert a significant public health impact on communities substantially burdened by HIV.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC) , where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

1Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA;

2Division of Primary Care and Population Sciences, Faculty of Medicine, and Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK;

3Department of Social Statistics and Demography, Faculty of Social Sciences , University of Southampton, Southampton, UK;

4Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA

5International Center for Research on Women, Washington, D.C., USA

6Human Sciences Research Council, Durban, South Africa

7Human Social Development, Human Sciences Research Council, Durban, South Africa

Correspondence and request for reprints to Dr. Lynae A. Darbes, Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N. Ingalls, RM 3341, Ann Arbor, MI 48109, USA

Conflicts of Interest and Source of Funding: National Institute of Health R01 086346 to Lynae Darbes. Nuala McGrath was supported by a Wellcome Trust fellowship (grant number WT083495MA). Victoria Hosegood was supported by the Economic and Social Research Council, UK (ESRC; ES/J021202/1). None of the authors declared any conflicts of interest.

LAD is currently at the Department for Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA

Portions of these results were presented by Lynae Darbes at the XXIst International AIDS Conference, Durban, South Africa, July 20th, 2016.

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