“We are in this together:” dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP

Abstract

Background A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART. Methods This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples’ HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples’ decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis. Results Three major themes were identified: (1) HIV as “two people’s secret” and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention. Conclusions The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.

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

“…This systematic review suggests that couple-based interventions have a stronger effect than individual-level interventions to boost condom use and encourage HIV testing among couples in RCTs. One possibility is that behavioral cooperation may help couples establish common goals in initiating healthy behaviors and developing a partnership based on joint decision-making and collective action toward reducing HIV transmission risks [ 13 ]. When both partners participate in couple-based interventions, they decrease discrepant perceptions of HIV transmission risks and increase their health literacy regarding HIV [ 39 ].…”

“…Evidence from prior research supports our findings that CHCT has been recognized as one of the most cost-effective intervention strategies in resource-constrained settings and is particularly strong in HIV-serodiscordant couples [ 43 ]. This may be explained by the mobilizing of shared resources within a couple that were previously rarely considered, including the awareness of the importance of sexual negotiation, and supporting once-scarce environmental resources such as the space for an open and private conversation with a trained counselor for CHCT and/or access to PrEP [ 12 , 13 ]. Although the evidence for cost-effectiveness analyses of skill-building intervention components remains to be clarified, future public health intervention strategies need to be weighted more toward resource-constrained areas with the objective to more effectively reduce HIV risk among couples.…”

“…A good illustration is HIV prevention between serodiscordant partners in which one partner has positive HIV status; even though HIV transmission is a persistent health threat to serodiscordant couples, they may not use condoms consistently [ 5 ] because condom use delegitimizes the trust and intimacy of a romantic relationship [ 6 ]. In such situations where individual resources are overwhelmed, partners can prevent HIV transmission while promoting trust and intimacy by calling on shared resources and efforts, including sexual negotiation [ 7 – 9 ], virus load suppression for the HIV positive partner (i.e., the outlook of “undetectable equals untransmittable” status; i.e., U = U) [ 8 , 10 , 11 ], as well as HIV counseling and testing [ 12 ], and access to pre-exposure prophylaxis (PrEP) [ 13 ] for the HIV-negative partner.…”

Your Family Connects: A Theory-Based Intervention to Encourage Communication about Possible Inherited Cancer Risk among Ovarian Cancer Survivors and Close Relatives

“…Few interventions have attempted to capitalize on family member roles and interactions to achieve appropriate family-wide risk communication [23]. Researchers have applied family systems theories to a variety of other health contexts including HIV-discordant couples [24], partners' smoking cessation [25][26][27][28], lung cancer patients' family members who smoke [29], and mother-daughter pairs for sexually transmitted infections prevention [30]. However, surprisingly little research has applied this thinking to family communication regarding risk assessment such as family history (e.g., Koehly et al [31]) or for people identified as high risk for hereditary breast and ovarian cancer (e.g., Peters et al [32]).…”

Making the Case for Joint Decision‐Making in Future Multipurpose Prevention Technology (MPT) Choice: Qualitative Findings on MPT Attribute Preferences from the CUPID Study (MTN‐045)

“…Positive and equitable predisposing characteristics can lead to a transformation of motivation and in turn, allows a couple to engage in communal coping where they cooperatively engage in health‐enhancing behaviours (e.g. MPT use) [ 43 , 44 , 45 , 46 , 47 ]. Given the importance of male partner involvement for many women and the potential for more open communication in relationships to increase HIV prevention and contraceptive use, facilitating equitable decision‐making processes that lead to the transformation of motivation among couples constitutes a promising strategy to support future MPT use.…”