Couples-based HIV counseling improves testing, viral suppression

Key takeaways:

• Counselors visited couples five times during pregnancy and postpartum to discuss HIV status and relationship skills.
• Couples who received home visits were more likely to get tested for HIV.

Home-based HIV counseling and relationship building improved HIV testing, diagnoses and viral suppression among pregnant couples during a trial in Kenya, researchers reported.

“The primary aim of the study was to increase uptake of couples-based counseling and testing for HIV,” Lynae Darbes, PhD, professor in the Center for Sexuality and Health Disparities at the University of Michigan School of Nursing, said during a press conference at the Conference on Retroviruses and Opportunistic Infections. “Testing together for HIV and strengthening couple relationship skills is important to achieve optimal family health during pregnancy, postpartum and beyond.”

In their study, the researchers randomly assigned 800 pregnant couples in Kenya to one of three arms. The intervention group received five home visits from counselors over the course of their pregnancy and postpartum to discuss pregnancy, relationship skills and HIV status. One of the comparison groups received HIV self-test kits to use in their homes, and the other received standard care. At baseline, two-thirds of the women in the study were living with HIV, Darbes said.

“We focused on this population of pregnant women as it is important to implement treatment and prevention strategies to this group to both prevent the spread of HIV to infants and partners, as well as to prevent women who are not living with HIV from becoming infected,” Darbes said.

The researchers interviewed the couples during pregnancy, then 3 months and 12 months postpartum.

Compared with the standard care group, couples who received home visits or HIV self-test kits were three to four times more likely to engage in couples HIV testing and counseling (adjusted RR = 4.22; 95% CI, 2.88-6.18; and 3.69; 95% CI, 2.5-5.45, respectively), according to the abstract.

Women with HIV in the home visit group were significantly more likely to achieve viral suppression at 18 months (aRR = 1.07; 1.03-1.12), the researchers reported.

Overall, two infants were born with HIV. Darbes said the home visits also led to more male HIV diagnoses and identified more serodiscordant couples.

“We also found improved relationship quality measures, such as satisfaction, trust and commitment ... in the home visit group,” she said. “Our results suggest that a couples-based approach can be successful for improving maternal and family health outcomes, including viral suppression for women living with HIV.”