Efficacy of a Telehealth Delivered Couples’ HIV Counseling and Testing (CHTC) Intervention to Improve Formation and Adherence to Safer Sexual Agreements Among Male Couples in the Us: Results from a Randomized Control Trial

Abstract

Background: There is a critical gap in HIV prevention science around the development of interventions that help male couples form and adhere to safer sexual agreements. This paper reports the results of a randomized controlled trial (RCT) to assess the efficacy of Nexus , a telehealth delivered intervention that combines Couples’ HIV Counseling and Testing (CHTC) with home-based HIV-testing, examining the impact of the intervention on the couples’ formation and adherence to safer sexual agreements. Methods: Between 2016 and 2018, 424 male couples were recruited online from across the U.S and equally randomized to the intervention arm (a telehealth delivered CHTC session with two home HIV-testing kits) or a control arm (two home HIV-testing kits), with study assessments at baseline, 3 and 6 months. Outcomes included the formation and adherence to safer sexual agreements, dyadic discordance in reporting sexual agreements, breakage of sexual agreements, and perceptions of the benefit of PrEP. Findings: Couples randomized to the intervention arm had significantly greater odds of reporting a safer sexual agreement (3 months OR 1.87, 95%CI 1.21-2.90, p-value 0.005, and 6 months OR 1.84, p-value 0.007), lower odds of reporting discordant sexual agreements at 6 months (OR 0.62, p-value 0.048), and a significantly lower odds of reporting breaking their sexual agreement (3 months OR 0.51, p-value 0.035, and 6 months OR 0.23, p-value 0.000). By 6 months, couples in the intervention arm were less likely to say PrEP was beneficial to one (RRR 0.33, P=0.000) or both of them (RRR 0.29, P=0.000) than being beneficial to neither of the partners. Interpretation: The high levels of acceptability and efficacy of the intervention demonstrate strong potential for the scale-up of this efficacious intervention that leverages existing interventions (CHTC) and delivers them through a low-cost telehealth platform to create significant behavioral change among male couples. Trial Registration: The study was registered on ClinicalTrials.gov (NCT02335138) Funding: The study was supported by National Institutes of Health (Grant No. R01HD078131). Declaration of Interest: The authors declare no competing interests. Ethical Approval: Ethical approval was obtained from the University of Michigan (HUM00102906) Institutional Review Board.