What did we find out?

What did we find out?
o    Lots of people participated and were interested in the study!
o    We screened over 1100 people who wanted to take part!
o    Here are some descriptions about the couples who were in the study:
    Overall, we had 332 couples participate
    Average age for women was 24 and for men 27
    9% of couples were married and 22% of couples lived together
    average length of relationship was 3 years
    35% of couples had a child together,  31% of couples neither partner had children
    45% had finished matric or higher
    Very low reports of outside partners (need to explore this more—why so different than other studies)
    Very low reports of intimate partner violence (need to explore this more—why so different than other studies)
    Even though HIV is a significant problem in the area, relatively few people had tested for HIV before coming to our study.
•    49% reported condom use at last sex
•    42% of the men had never been tested for HIV, and 38% of the women had never tested for HIV.
•    In 25% of couples neither partner had ever tested for HIV
•    Of those at baseline who reported previously testing for HIV
o    Only 40% had disclosed their result to anyone
o    Only 20% had disclosed their results to their study partner
•    This shows that there is a need for a program like this in the community to help people get tested for HIV.
o    We found out that our program did help couples get tested together for HIV. More couples that participated in our program got tested for HIV than the couples who did not get the program. Couples who participated in Uthando Lwethu also tested for HIV quicker than the other couples.
o    We thought that couples would need several counseling sessions to help them make the decision to test together for HIV. But many couples tested before finishing their couples counseling sessions.
o    BUT –even the couples who tested for HIV soon after starting the program still finished their couples counseling sessions. Meaning, they still found them helpful and were committed to finishing the program.
o    Over 90% of couples stayed with the study throughout the 9-month follow up phase. This number is very impressive when compared to other studies (even individual-level studies).
o    Specific numbers for our outcome:
    71 couples who participated in the intervention participated in CHTC: 46% were concordant HIV-negative,  30% were concordant HIV-positive, and 24% were serodiscordant (majority female HIV-positive)
    20 couples from control group participated in CHTC: 55% were concordant HIV-negative, 30% were concordant HIV-positive, 15% were discordant (majority male HIV-positive)
    Reduction in sexual risk behavior (reduced unprotected sex with primary partner) at first follow-up but did not continue for later follow-ups

Implementation
o    Group and couples’ counseling sessions were facilitated by lay counselors from the community
o    Counselors were trained by other staff and were able to deliver couples’ communication skills, relationship skills, and education to couples
o    A “training of the trainers” model would work to continue this project in that new counselors could be trained to implement intervention
o    Intervention was delivered in the community by using mobile vans.
o    It is possible that the intervention could be delivered in fewer sessions. Currently, it was delivered in 2 group sessions and 4 couples counseling sessions. It is possible that this could be condensed to fewer sessions and possibly eliminate or reduce the group sessions. Further analysis will help us answer this question, as feasibility is an important issue for future implementation.
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Key Messages

    Participating in the Uthando Lwethu program helped more couples get tested for HIV together.
    Couples in Uthando Lwethu got tested for HIV quicker than other couples.
    Most couples in Uthando Lwethu completed their couples counseling sessions (4 sessions)—whether or not they had tested for HIV already.
    The Uthando Lwethu program especially helped couples with their positive communication and improved male gender norms, or men’s attitudes about gender relations.
    Helping couples learn communication skills and improve their relationship quality seems to help them make the decision to get tested together for HIV—which can be a difficult decision for couples.
    Testing together for HIV can be a powerful tool against HIV in the community. Couples find out their own and their partner’s HIV status and learn how to stay HIV-negative or how to get treatment for HIV, if HIV-positive. They also learn how to not infect their partner with HIV and how to make plans for the future to keep both partners healthy.

Recommendations
o    Provide services for couples—helps to engage men.
o    Provide general relationship-building skills, including communication. Can improve relationships as well as other health behaviors, such as sexual risk behaviors.
o    Combine skills and information—allow enough time for couples to practice what they are learning and absorb the skills and information (not just one session, and adequate time in between sessions)
o    Utilize teams of mixed-gender staff when working with couples.
o    Be flexible and allow some tailoring to individual needs of couples
o    Mobile services allow access for couples that may have difficulty going to clinics together.


Future Steps
We were happy that so many couples came to our program, and that we were able to help them make the decision to test together for HIV. Our hopes for the future are that:
    We can work with local community-based organizations to adapt Utando Lwethu so that it can continue to be used with couples in the community.
    We will work with community leaders and health workers to adapt the program so that staff at local organizations can implement the program.
    It is possible that the program could be adapted to help couples who are coping with intimate partner violence or alcohol abuse.
    Possible future intervention to improve treatment engagement and retention for couples who participate in CHTC