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HIV Testing and Counselling for Couples

Adapting an existing intervention to substantially enhance promotion of couples HIV testing and counselling among couples who have never tested together for HIV or mutually disclosed their status.

South Africa has experienced one of the most severe generalised HIV epidemics in the world. More than two thirds of HIV-infected adults worldwide live in sub-Saharan Africa. The majority of new infections occur within heterosexual partnerships but there can be a reluctance to embrace repeat HIV testing and to disclose HIV status to sexual partners. A theory-based behavioural couples-focused intervention, led by Professor Lynae Darbes, (Uthando Lwethu) was designed to encourage couples to test for HIV together. The trial successfully increased the proportion of couples that decided to learn their HIV status together: 42% of couples had tested 9 months after joining the programme, compared to 12% in the control group.

The improvement in take up of testing was impressive, but what about the remaining 58% who chose not to test together? Understanding the couples’ characteristics and learning how we can best reach out to these individuals became the starting point for the next stage of our work. Working with the Human Sciences Research Council, we reached out to the couples we worked with in the original trial (in KwaZulu-Natal) to hear their experiences in the hope that we might modify our original intervention approach and improve the number of couples who test together for HIV.

The next steps...

Igugu Lethu (Cherishing Our Relationship)

A qualitative study was conducted from August to October 2019 with 20 purposively sampled couples who were formerly enrolled in the intervention arm of the Uthando Lwethu Study, and with 5 study staff who delivered intervention components, with the aim of exploring experiences of the intervention and barriers to testing, to inform the optimisation of the intervention.

Using the Person-Based Approach to intervention development and optimisation, a table of changes was developed using verbatim quotes from the interview transcripts. Possible changes were considered and triangulated with logistic regression analyses of the quantitative data from the Uthando Lwethu study, through discussion at a post-study participant event and with the Igugu Lethu community working group, whose contributions resulted in further amendments to the revised intervention. We will now measure the efficacy of our optimised theory-based and culturally appropriate couples-focused intervention on the uptake of HIV-testing as a couple in a prospective cohort study called ‘Igugu Lethu’ (Cherishing our relationship).