Background: Couples-based HIV testing and counseling (CHTC) is an effective strategy for reducing sexual transmission between partners. However, uptake of the service has been low. We tested the efficacy of a couples-based intervention to increase participation in CHTC in a high HIV-prevalence setting.
Methods: We randomized 332 couples (664 individuals) from a rural community in KwaZulu-Natal South Africa for an RCT of a couples-based behavioral intervention comprising six sessions (two group sessions/four couple counseling sessions) (n= 168 couples) or one group session (n = 164 couples). The intervention explored barriers to HIV testing and promoted improved communication skills and positive relationship dynamics. The primary outcomes were participation in CHTC and number of reported unprotected sex acts in the last 90 days with primary partner. Couples were ineligible if they had mutually disclosed their HIV status or previously participated in CHTC.
Results: 22 couples (6%) were lost-to-follow-up before 9 months, with no difference by group, p=0.36. Using intent-to-treat analysis, at final 9-month follow-up, a higher proportion of intervention couples had participated in CHTC than control couples (42% and 12% respectively; p ≤ 0.001), with a shorter time to CHTC than control group couples who participated in CHTC (Logrank p ≤ 0.0001). For sexual behavior, there was a significant reduction in proportion of unprotected sex acts for intervention couples at 3-month follow-up (IRR = 0.74, p ≤ 0.022), but a negative binomial regression model accounting for couple clustering found no significant group-by-time interaction (p=0.08).
Conclusions: To our knowledge, this is the first intervention that targeted increasing participation in CHTC. Results suggest that addressing relationship factors among African heterosexual couples can significantely improve rates of CHTC. The intervention had an impact on proportion of unprotected sex acts at first follow-up but this was not sustained over time. Our intervention reached a high number of couples that were unaware of their joint HIV status at baseline. Further, results show that it is possible to promote engagement in CHTC-- which is an effective strategy that accomplishes HIV testing, mutual disclosure and can facilitate entrée into treatment for HIV-positive individuals in high prevalence settings.