Abstract
BackgroundHIV counseling and testing for couples is an important component of HIV prevention strategies, particularly in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors.MethodsThis study involved offering CHCT and CFP services to couples in their homes; 180 couples were sampled from households in a peri-urban area of Blantyre. Baseline data were collected from both partners and follow-up data were collected one week later. A pair of male and female counselors approached each partner separately about HIV testing and counseling and contraceptive services and then, if both consented, CHCT and CFP services (pills, condoms and referrals for other methods) were given. Bivariate and multivariate logistic regression analyses were done to examine the relationship between individual partner characteristics and acceptance of the services. Selected behaviors reported pre- and post-intervention, particularly couple reports on contraceptive use and condom use at last sex, were also tested for differences.Results89% of couples accepted at least one of the services (58% CHCT-only, 29% CHCT + CFP, 2% CFP-only). Among women, prior testing experience (p < 0.05), parity (p < 0.01), and emotional closeness to partner (p < 0.01) had significant bivariate associations with acceptance of at least one service. Reported condom use at last sex increased from 6% to 25% among couples receiving any intervention. First-ever HIV testing was delivered to 25 women and 69 men, resulting, respectively, in 4 and 11 newly detected infections.ConclusionsHome-based CHCT and CFP were very successful in this pilot study with high proportions of previously untested husbands and wives accepting CHCT and there were virtually no negative outcomes within one week. This study supports the need for further research and testing of home- and couple-based approaches to expand access to HCT and contraceptive services to prevent the undesired consequences of sexually transmitted infection and unintended pregnancy via unprotected sex.
Highlights
HIV counseling and testing for couples is an important component of HIV prevention strategies, in Sub Saharan Africa
Of the 167 couples offered couple HIV counseling and testing (CHCT) + couple family planning (CFP) services, 48 (29%) accepted the combined service intervention; 97 (58%) consented to CHCT only; 4 (2%) to CFP only and 18 (11%) declined any intervention (17 women declined and one man declined after the wife had accepted CHCT)
This study was unique in offering both contraceptive and HIV counseling and testing to couples in their homes
Summary
HIV counseling and testing for couples is an important component of HIV prevention strategies, in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors. The impetus for couplebased interventions has increased in recent years [6] One reason for this is the belated recognition that in subSaharan Africa a large proportion of HIV infections occur within the context of stable relationships either as a result of previous infection or infidelity [7,8]. De Walque reported that in five African countries, two-thirds or more of couples with at least one HIV-infected partner were serodiscordant [9]
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