Overview

New WHO guidelines recommend offering HIV testing and counselling to couples, wherever HIV testing and counselling is available, including in antenatal clinics. For couples where only one partner is HIV positive, the guidelines recommend offering antiretroviral therapy to the HIV positive partner, regardless of his/her own immune status (CD4 count), to reduce the likelihood of HIV transmission to the HIV negative partner.

Today, only 40% of people with HIV globally know their HIV status. Up to 50% of HIV-positive people in on-going relationships have HIV-negative partners (i.e. they are in serodiscordant relationships). Of those HIV-positive individuals who know their status, many have not disclosed their HIV status to their partners, nor do they know their partners’ HIV status. Consequently, a significant number of new infections occur within serodiscordant couples.

CHTC offers couples the opportunity to test, receive their results and mutually disclose their status in an environment where support is provided by a counsellor/health worker. A range of prevention, treatment and support options can then be discussed and decided upon together, depending on the status of each partner.

Recent evidence confirms the benefit of early ART for people with a CD4 count above 350 cells/µL in preventing transmission to HIV-negative partners. In order to benefit from such opportunities, couples should be supported to test together and disclose their status to each other and access prevention, care and treatment services.

Contents

• ABBREVIATIONS AND ACRONYMS
• ACKNOWLEDGEMENTS
• DECLARATIONS OF INTEREST
• EXECUTIVE SUMMARY
• 1. OVERVIEW
  • 1.1 Background
  • 1.2 Key definitions for couples HTC
  • 1.3 Objectives
  • 1.4 Target audiences
  • 1.5 Scope
  • 1.6 Process of formulating guidelines
  • 1.7 Strength of the recommendations
• 2. DISCUSSION OF RECOMMENDATIONS
  • 2.1 Couples HIV testing and counselling
  • 2.2 ART for prevention in serodiscordant couples
• 3. GUIDING PRINCIPLES FOR IMPLEMENTATION
  • 3.1 Voluntary utilization of testing services
  • 3.2 Five Cs—consent, confidentiality, counselling, correct test results, link to care
  • 3.3 Access to justice
  • 3.4 Human rights
  • 3.5 Provision of earlier treatment
• 4. OPERATIONAL ISSUES FOR IMPLEMENTATION
  • 4.1 Overarching issues
  • 4.2 Antenatal, perinatal and postnatal care
  • 4.3 Other clinical settings
  • 4.3.1 What is needed going forward
  • 4.4 Community programmes and settings
• 5. ADAPTING THE GUIDELINES
• 6. RESEARCH GAPS
  • 6.1 Epidemiology of serodiscordance
  • 6.2 Impact of couples HTC and treatment as prevention
• 7. PRE-EXPOSURE PROPHYLAXIS (PrEP)
• REFERENCES
• ANNEXES
  • ANNEX 1 PICO Questions
  • ANNEX 2 Outcome Frameworks
  • ANNEX 3 GRADE Notation and Language
  • ANNEX 4 GRADE Evidence Profiles
  • ANNEX 5 Risk-Benefit Tables
  • ANNEX 6 Evidence Summaries – Results and Findings
  • ANNEX 7 Search Strategies
  • ANNEX 8 References
  • ANNEX 9 Community Voices
  • ANNEX 10 Implementation Plan
  • ANNEX 11 Concerns about intimate partner violence (IPV) following CHTC
  • ANNEX 12 Evidence-based interventions for HIV serodiscordant couples
  • ANNEX 13 Summary of declarations of interest

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