Abstract
BackgroundUptake of couples’ HIV counseling and testing (couples’ HCT) services remains largely low in most settings. We report the effect of a demand-creation intervention trial on couples’ HCT uptake among married or cohabiting individuals who had never received couples’ HCT.MethodsThis was a cluster-randomized intervention trial implemented in three study regions with differing HIV prevalence levels (range: 9–43 %) in Rakai district, southwestern Uganda, between February and September 2014. We randomly assigned six clusters (1:1) to receive the intervention or serve as the comparison arm using computer-generated random numbers. In the intervention clusters, individuals attended small group, couple and male-focused interactive sessions, reinforced with testimonies from ‘expert couples’, and received invitation coupons to test together with their partners at designated health facilities. In the comparison clusters, participants attended general adult health education sessions but received no invitation coupons. The primary outcome was couples’ HCT uptake, measured 12 months post-baseline. Baseline data were collected between November 2013 and February 2014 while follow-up data were collected between March and April 2015. We conducted intention-to-treat analysis using a mixed effects Poisson regression model to assess for differences in couples’ HCT uptake between the intervention and comparison clusters. Data analysis was conducted using STATA statistical software, version 14.1.ResultsOf 2135 married or cohabiting individuals interviewed at baseline, 42 % (n = 846) had ever received couples’ HCT. Of those who had never received couples’ HCT (n = 1,174), 697 were interviewed in the intervention clusters while 477 were interviewed in the comparison clusters. 73.6 % (n = 513) of those interviewed in the intervention and 82.6 % (n = 394) of those interviewed in the comparison cluster were interviewed at follow-up. Of those interviewed, 72.3 % (n = 371) in the intervention and 65.2 % (n = 257) in the comparison clusters received HCT. Couples’ HCT uptake was higher in the intervention than in the comparison clusters (20.3 % versus 13.7 %; adjusted prevalence ratio (aPR) = 1.43, 95 % CI: 1.02, 2.01, P = 0.04).ConclusionOur findings show that a small group, couple and male-focused, demand-creation intervention reinforced with testimonies from ‘expert couples’, improved uptake of couples’ HCT in this rural setting.Trial registrationClinicalTrials.gov, NCT02492061. Date of registration: June 14, 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1720-y) contains supplementary material, which is available to authorized users.
Highlights
Uptake of couples’ Human Immunodeficiency Syndrome (HIV) counseling and testing services remains largely low in most settings
In 2014, the Joint UN Program on HIV/AIDS (UNAIDS) released new targets dubbed “90-90-90”: 90 % of people living with HIV are aware of their HIV status; 90 % of people living with HIV have been enrolled into HIV care; and 90 % of people living with HIV who are enrolled in HIV care have reached viral suppression by 2020 [1]
These findings suggest that the use of small group, couple and male-focused interactive sessions reinforced with testimonies from ‘expert couples,’ can improve couples’ HIV counselling and testing (HCT) uptake in this rural setting
Summary
Uptake of couples’ HIV counseling and testing (couples’ HCT) services remains largely low in most settings. Couples’ and partner HIV testing can improve timely identification and enrolment into HIV care among men who usually report late for HIV diagnosis and enroll late into HIV care [2]. Evidence from Demographic and Health Surveys [4] as well as from population-based studies [5] suggest that between one-half to two-thirds of HIV-affected married or cohabiting couples have at least one partner who is HIV-positive; but only less than 30 % of such couples are aware of their partners’ HIV status [6]. Recent scientific evidence points to the need for immediate enrolment of HIV-positive individuals into HIV care [7, 8], individuals can only enroll into HIV care if they are tested and are aware of their own HIV status. Fewer couples have tested together or disclosed their HIV status to each other [6, 9, 10], presenting a missed opportunity for timely enrolment into HIV care among HIV-discordant and concordant HIV-positive couples
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