Adaptation of the African couples HIV testing and counseling model for men who have sex with men in the United States: an application of the ADAPT-ITT framework.

Patrick S Sullivan,Ann Schwartz,Beau Grazter,Jeanne Montgomery,Laura Salazar,Susan Allen,Ralph Diclemente,Colleen Hoff,Gina Wingood,Rob Stephenson,Kristina Grabbe,Jasper Barnes,Lamont Scales

doi:10.1186/2193-1801-3-249

Abstract

To respond to the need for new HIV prevention services for men who have sex with men (MSM) in the United States, and to respond to new data on the key role of main partnerships in US MSM epidemics, we sought to develop a new service for joint HIV testing of male couples. We used the ADAPT-ITT framework to guide our work. From May 2009 to July 2013, a multiphase process was undertaken to identify an appropriate service as the basis for adaptation, collect data to inform the adaptation, adapt the testing service, develop training materials, test the adapted service, and scale up and evaluate the initial version of the service. We chose to base our adaptation on an African couples HIV testing service that was developed in the 1980s and has been widely disseminated in low- and middle-income countries. Our adaptation was informed by qualitative data collections from MSM and HIV counselors, multiple online surveys of MSM, information gathering from key stakeholders, and theater testing of the adapted service with MSM and HIV counselors. Results of initial testing indicate that the adapted service is highly acceptable to MSM and to HIV counselors, that there are no evident harms (e.g., intimate partner violence, relationship dissolution) associated with the service, and that the service identifies a substantial number of HIV serodiscordant male couples. The story of the development and scale-up of the adapted service illustrates how multiple public and foundation funding sources can collaborate to bring a prevention adaptation from concept to public health application, touching on research, program evaluation, implementation science, and public health program delivery. The result of this process is an adapted couples HIV testing approach, with training materials and handoff from academic partners to public health for assessment of effectiveness and consideration of the potential benefits of implementation; further work is needed to optimally adapt the African couples testing service for use with male–female couples in the United States.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-249) contains supplementary material, which is available to authorized users.

Highlights

Since the earliest reports of AIDS in the United States, men who have sex with men (MSM) have been, and continue to be, the most adversely affected risk group in the US HIV epidemic (Sullivan and Wolitski 2007)
We chose to work with the existing African couples HIV testing and counseling approach because there was no Centers for Disease Control and Prevention (CDC)-endorsed HIV testing or counseling Evidence-based intervention (EBI) for male couples on www.effectiveinterventions.org, because of the robust training materials available for the African couples’ approach, and because of the substantial evidence for the prevention value of the African couples’ approach
Men in the MSM focus groups did not attend as couples, and HIV status was not an eligibility criterion; in most MSM groups, one or more men identified themselves as living with HIV during the discussion

Summary

Introduction

Since the earliest reports of AIDS in the United States, men who have sex with men (MSM) have been, and continue to be, the most adversely affected risk group in the US HIV epidemic (Sullivan and Wolitski 2007). Male couples represent a high-priority group for HIV prevention interventions, because primary partners have been identified as the source of approximately one-third (Goodreau et al 2012) to two-thirds (Sullivan et al 2009) of HIV infections among MSM. Risky episodes with casual partners are often not disclosed to main partners (Gomez et al 2012; Hoff et al 2010; Gass et al 2012). Each of these factors highlights the need for targeted HIV prevention services for male couples. The Office of the Global AIDS Coordinator, through dissemination of prevention guidelines for MSM in countries supported by the President’s Emergency Plan for AIDS Relief (PEPFAR), has recommended couples testing for male couples based on the strength of evidence from observational studies of heterosexual couples (PEPFAR 2011)

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