Biomedical and behavioral outcomes of 2GETHER: A randomized controlled trial of a telehealth HIV prevention program for young male couples.

Abstract

Objective: This study evaluated the efficacy of the 2GETHER relationship education and HIV prevention program for young male couples in reducing risk for HIV. Method: We conducted a comparative effectiveness randomized controlled trial of 2GETHER, a five-session hybrid group-and couple-based intervention delivered via videoconference, relative to a single-session HIV testing and risk reduction counseling protocol delivered to couples. We randomized 200 young male couples (N = 400) to 2GETHER or control from 2018 to 2020. Primary biomedical (i.e., rectal Chlamydia and Gonorrhea infection) and behavioral outcomes (i.e., condomless anal sex [CAS]) were measured at 12-months postintervention. Secondary outcomes were other HIV prevention and risk behaviors, relationship quality, and substance use. Multilevel regression was used to model intervention outcomes to account for clustering within couples. Postintervention change over time was modeled as a latent linear growth curve at the within-persons level. Results:We observed significant intervention effects on primary biomedical and behavioral HIV risk outcomes. Participants in 2GETHER had significantly lower odds of rectal STIs at 12-months relative to control. We also observed significantly steeper declines in the number of CAS partners and acts from baseline to 12-month follow-up in 2GETHER relative to control. Few differences were observed for secondary relationship and HIV-related outcomes. Conclusions: 2GETHER is an efficacious intervention that has a significant impact on both biomedical and behavioral HIV prevention outcomes among male couples. Couple-based HIV prevention programs enhanced with evidence-based relationship education may effectively reduce the most proximal predictors of HIV infection.What is the public health significance of this article? This comparative effectiveness randomized controlled trial establishes the efficacy of 2GETHER, a relationship education and HIV prevention program for young male couples, in improving biomedical and behavioral indicators of HIV risk. These findings suggest that enhancing couple-based HIV preventive interventions with relationship education is an effective strategy for reducing proximal risk factors for HIV young male couples.

Understanding the potential implementation determinants of Our Plan: a couples-based digital human immunodeficiency virus prevention intervention for same-gender male couples

“…Importantly, participants discussed several plausible configurations for integrating Our Plan into existing workflows that could bolster organizational capacity (e.g., increased referrals, improved retention, reducing staff effort). Their thoughts and excitement collectively confirmed that efforts to develop couples-based and couples-focused DHIs for sexual minority male couple/dyad groups have and will continue to be central to HIV prevention and treatment efforts writ large ( 6 , 8 - 10 ).…”

“…Simultaneously, there has been a proliferation in the development and use of digital technologies to improve health [e.g., native applications (apps), webapps, telephone/video conference, social media websites], including for HIV prevention-care continua outcomes, as a mechanism to help circumvent barriers to in-person interventions and services ( 13 ). Several couples-based and couples-focused digital health interventions (DHIs) have been developed for sexual minority male couples ( 6 , 8 - 10 , 14 ). DHIs have the potential to offer many benefits, such as overcoming geographic and economic access barriers, convenience, and privacy ( 15 , 16 ).…”

“…While acceptability, feasibility, and preliminary efficacy of couples-based DHIs for HIV/STI prevention-care have been demonstrated in research contexts ( 6 , 9 , 10 , 14 ), less is known about the barriers and facilitators for implementation within community-based organizations. Wide-scale uptake and sustainability of DHIs for HIV/STI prevention among couples in real world contexts requires a better understanding of what specific determinants may help or hinder implementation.…”

Effectiveness of PrEPTECH: Findings From a 180-Day Randomized Controlled Trial of a Pre-Exposure Prophylaxis Telehealth Intervention

“…A trial of an online dyadic counseling intervention for HIV prevention did not find any significant gains in PrEP use among those randomized to the intervention arm. 32 In this study, we report on findings related to effectiveness from a randomized controlled trial of PrEPTECH ( ClinicalTrials.gov NCT04902820), a telehealth intervention that aims to tackle the challenges of accessing PrEP that young people encounter in traditional models of care. 33 …”