A systematic review of couples-based behavioral interventions associated with HIV prevention
Presented by Caitlin Kennedy (United States).
C. Kennedy1, V. Bhatia2, K. Grabbe3, I. Iuppa2, G. Kennedy2, E. Marum3
1Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, United States, 2University of California at San Francisco, San Francisco, United States, 3Centers for Diease Control and Prevention, Global AIDS Program, Atlanta, United States
Background: Increasing global investment in HIV prevention has created debate regarding the most effective intervention strategies. Interventions targeting couples may be efficacious, possibly more efficacious than individual interventions, but the evidence base is unclear.
Methods: We conducted a systematic review of couples-based behavioral interventions for outcomes associated with HIV prevention by comprehensively searching electronic databases and journals from January 1980-March 2009, and reviewing secondary references. Inclusion criteria were:
(1) multi-arm or pre-post study design,
(2) intervention targeting heterosexual couples for HIV prevention behavior change, and
(3) measured outcomes including
(a) biological (HIV/STI incidence/prevalence),
(b) behavioral (condom use, # sexual partners), or
(c) other preselected outcomes (violence, disclosure, communication).
Results: Of 4,239 citations reviewed, 20 studies met inclusion criteria (10 sub-Saharan Africa, 7 United States, 1 Haiti, 1 China, 1 multi-site). Twelve studies involved HIV counseling and testing, 6 involved other behavioral interventions, and 2 involved partner notification. Target populations included couples in the general population (4), Hispanics/Latinos (2), pregnant women/ partners (5), and HIV-infected individuals/ partners (9). Study designs varied. Couples-based interventional studies with a control/ comparison group were effective for most measured outcomes. Couples-based interventions were also more effective for HIV incidence, nevirapine uptake, and couple communication, compared with individually-based interventions. There was no clear difference for condom use. Few studies measured negative outcomes, such as violence, or focused on HIV-discordant couples.
Conclusions: Couples-based behavioral interventions for HIV prevention are effective, and appear more effective than individual-based interventions for some outcomes, including HIV incidence. Additional studies are needed, particularly with discordant couples, to provide stronger evidence for programmatic decision-making. Future studies should employ rigorous designs, examine negative outcomes, and measure partner serostatus to contextualize behavioral outcomes.
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