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Results of a Couples-Based Randomized Controlled Trial Aimed to Increase Testing for HIV

Darbes, Lynae A., PhDa,b; McGrath, Nuala M., PhDc,d; Hosegood, Victoria, PhDd; Johnson, Mallory O., PhDa; Fritz, Katherine, PhDe; Ngubane, Thulani, MTHf; van Rooyen, Heidi, PhDg

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1, 2019 - Volume 80 - Issue 4 - p 404–413
doi: 10.1097/QAI.0000000000001948
Prevention Research
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Background: Although couples 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 (eg, markets and 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 6 months. Assessments occurred at baseline, and 3, 6, and 9 months after 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 4 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 behavior.

Results: Overall, 334 couples were enrolled. Intervention couples were significantly more likely to have participated in CHTC [42% vs. 12% (P ≤ 0.001)]. In addition, 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.

Conclusions: 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.

aCenter for AIDS Prevention Studies, Division of Prevention Sciences, University of California, San Francisco, San Francisco, CA;

bCurrently, Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI;

cDivision of Primary Care and Population Sciences, Faculty of Medicine, Southampton, United Kingdom;

dDepartment of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, United Kingdom;

eInternational Center for Research on Women, Washington, DC;

fHuman Sciences Research Council, Durban, South Africa; and

gHuman Social Development, Human Sciences Research Council, Durban, South Africa.

Correspondence to: Lynae A. Darbes, PhD, 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 (e-mail: lynaed@umich.edu).

National Institute of Health R01 086346 to L.A.D. N.M.M. was supported by a Wellcome Trust fellowship (grant number WT083495MA). V.H. was supported by the Economic and Social Research Council, United Kingdom (ESRC; ES/J021202/1).

Presented in part by L.A.D. at the XXI International AIDS Conference; July 20, 2016; Durban, South Africa.

The authors have no conflicts of interest to disclose.

L.A.D. designed the study, obtained the funding, directed the implementation of the study, and wrote the first draft of the report; N.M.M. contributed to the design of the study, participated in implementation of the study, conducted the statistical analyses, and wrote and edited portions of the report; V.H., M.O.J., and K.F. contributed to the design of the study, participated in the implementation of the study, and edited the draft of the report; T.N. led the implementation of the study, supervised the study staff, and edited the report, H.V.R. contributed to the design of the study, directed the implementation of the study, and edited the draft of the report.

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.

Received June 11, 2018

Accepted December 14, 2018

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