Implementing Couple’s Human Immunodeficiency Virus Testing and Counseling in the Antenatal Care Setting

Abstract

OBJECTIVE: To describe a pilot implementation of couple’s human immunodeficiency virus (HIV) testing and counseling in an antenatal care clinic in the United States. METHODS: We used a cross-sectional study design. Couples were recruited from an antenatal care clinic of a large, urban, tertiary medical center, and were eligible if both partners agreed to receive HIV test results together and reported no coercion to participate in testing and counseling and no intimate partner violence. We assessed relationship characteristics, HIV risk-related behaviors and concordance of couples' sexual agreement (ie, mutual agreement about sexual risk behaviors that are permissible within or outside of their relationship). Acceptability of couple’s HIV testing and counseling (ie, format, quality of the sessions, ability to meet their needs) was assessed after completing the session. Barriers and facilitators to couple’s HIV testing and counseling were assessed at the individual-level among decliners and participants and at the clinic-level among members of the care team. RESULTS: Dyadic data were collected from 82 individuals (41 couples). Most partners (n=56, 68%) did not have a sexual agreement or had differing expectations about their sexual agreement. Partners with a concordant sexual agreement (n=26) felt more confident working with their partners on condom use when having sex outside of their relationship (P=.008) and were more likely to agree with their partner to get tested regularly for HIV or sexually transmitted infections (P=.015). Acceptability was high, with a rating of 93 or more (out of 100) among all items. Individual-level barriers to couple’s HIV testing and counseling included difficulty bringing the male partner for counseling and a perception by either member of the couple that they were at low-risk for HIV. At the clinic level, need for training, staff turnover, and integration of couple’s HIV testing and counseling in the clinic flow presented as barriers, whereas commitment by the clinic leadership facilitated the couple’s HIV testing and counseling program. CONCLUSION: Despite barriers, couple’s HIV testing and counseling can be implemented in antenatal clinics and is a highly acceptable method of HIV testing.

Couple-Centered HIV Prevention and Care: Endorsement, Practice and Uncertainty among US Healthcare Providers in Western-Central Upstate New York

“…Study findings here revealed that the current sample of health care providers overall endorsed CHTC as an HIV testing and care engagement modality. Other studies have found the same, for example in the U.S., formative work has found that both health consumers and health providers, support active couple-based modalities for HIV/STI prevention and care 15,35 as a way for mitigating transmission. Leblanc et al (2019) found that among 22 U.S. health providers endorsed CHTC and thought that it made sense when attempting to mitigate HIV transmission between partners and within communities.…”

Evidence and implication of interventions across various socioecological levels to address HIV testing uptake among men who have sex with men in the United States: A systematic review

“…Secondary analyses of “2GETHER” intervention further revealed the increased motivation to test for HIV with one’s partner for MSM with high internalized stigma. 48 However, given the low coverage of CHTC and multi-level barriers to the implementation but high willingness to use this service among MSM, 22 , 99 , 100 , 101 there remains a need for more research on the development, implementation and promotion of male couple-based interventions.…”

Missed Opportunities for HIV Prevention in Perinatal Care Settings in the United States

“…Very few studies in the US have assessed attitudes toward or effectiveness of interventions to offer HIV testing to partners of pregnant people. The studies that have been done have demonstrated a desire for partner testing but have also highlighted low uptake of testing and multiple barriers to testing ( 34 , 35 , 37 ).…”

“…Couples' HIV testing has been evaluated for its ability to increase condom use within a partnership, and is effective, but studies in the US have primarily been done outside of the context of pregnancy and prenatal care ( 36 ). In one urban academic antenatal care setting in the US, couples who received couples HIV testing and counseling reported a very high level of acceptability and increased ease in having conversations around safe sex ( 37 ). However, only 8% of eligible couples consented for the study.…”