Do Couple-Based Interventions Show Larger Effects in Promoting HIV Preventive Behaviors than Individualized Interventions in Couples? A Systematic Review and Meta-analysis of 11 Randomized Controlled Trials

Abstract

This systematic review and meta-analysis aims to compare the effects of couple-based prevention interventions against individual-level interventions on HIV prevention in randomized controlled trials (RCTs), identify potential moderators, and assess study quality. Eleven RCTs were included, comprising 3933 couples in the intervention group and 7125 individuals in the individual control group, predominantly in heterosexual couples from the USA and Africa. Couple-based interventions had a more significant effect in promoting condom use and HIV testing. Education levels of high school or above, residence in low- and middle-income countries, and intervention design incorporating HIV counseling and testing were associated with higher odds of condom use. The quality assessment analysis identified methodological and theoretical heterogeneity factors. Evidence of couple-based HIV prevention RCTs among men who have sex with men, injecting drug users, sex workers, and transgender women warrant further investigation. Recommendations are made to improve the quality and replicability of future intervention studies.

Barriers, Facilitators, and Strategies to Improve Participation of a Couple-Based Intervention to Address Women’s Antiretroviral Therapy Adherence in KwaZulu-Natal, South Africa

“…For example, Crepaz and colleagues [ 6 ] showed in a meta-analysis that CBIs (as opposed to individual interventions) resulted in increased odds (odds ratios between 1.51 to 1.79) of HIV testing, condom use, and nevirapine uptake to reduce mother to child transmission of HIV. Similar findings have been shown by other researchers [ 7 , 8 ], including studies conducted in South Africa [ 9 , 10 ]. To date, however, only two studies in the USA have tested the use of a CBI to improve ART adherence, and both found it to be superior to usual care in serodiscordant couples [ 11 , 12 ].…”

“…CBIs offer an advantageous approach over individual-based interventions in improving several HIV-related outcomes [6][7][8][9][10]. Our ultimate goal is to add to this body of knowledge by examining the effect of a CBI targeting women's ART adherence in KwaZulu-Natal.…”

Demand creation for HIV testing services: A systematic review and meta-analysis

“…Provision of information and counseling messages continue to be important; we found evidence that couples counseling and motivation-oriented counseling approaches are effective. Couples counseling is effective and widespread in many contexts [ 139 ]; motivation-oriented counseling is less broadly scaled and may merit further expansion; economic empowerment interventions may have broad reaching effects beyond HTS [ 140 ]. However, individualized messaging—both personalized messages and personal invitation letters—had minimal impact on uptake of HTS and may be considered for de-prioritization.…”