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J Acquir Immune Defic Syndr. 2019 Jan 30. doi: 10.1097/QAI.0000000000001948. [Epub ahead of print]

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

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Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA.
Division 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.
Department of Social Statistics and Demography, Faculty of Social Sciences , University of Southampton, Southampton, UK.
International Center for Research on Women, Washington, D.C., USA.
Human Sciences Research Council, Durban, South Africa.
Human Social Development, Human Sciences Research Council, Durban, South Africa.



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.


The Vulindlela district of KwaZulu-Natal, South Africa.


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.


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.


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.

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