If couples test for HIV together, will it improve uptake of health services? 

A couples-focused intervention aimed at promoting couples’ HIV testing and counselling has found that it will.

Igugu Lethu, a joint study between the Human Sciences Research Council and the University of Southampton, recruited 218 couples from Sweetwaters in KwaZulu Natal. The community experiences high rates of infectious diseases such as HIV and TB, as well as non-communicable disease. 

“The goal of the Igugu Lethu Study was to test whether a couples-focused intervention could help such couples to decide to test together for HIV because there is evidence that when couples are both aware of their HIV status as a couple they can better respond to the results and plan their future together,” explains Nuala McGrath, lead author of the study.

Couples were also offered screening and support for other health conditions including diabetes. More than half of the 218 couples who enrolled in the study-122 couples (56%)- decided to test for HIV together and were also offered options to be screened for other medical conditions, including sexually transmitted infections such as chlamydia and gonorrhoea.

“Among the couples, who tested for HIV, 64% of the couples had positive HIV results for at least one of the two partners. These couples were encouraged to attend a health clinic together as soon as possible,” says McGrath.

Couples were provided with referral letters to take to the clinic medical providers, and follow-up calls were made after a week to check whether they had gone to the clinic. They also attended the clinic for HIV treatment on average six days after receiving their HIV results. 

Benefits of couples testing together for HIV

McGrath says that this approach can also help to identify more people who will benefit from starting HIV treatment. 

“We think the findings from this study  should be recommended in real life settings and we will be discussing next steps with the Department of Health. The Igugu Lethu Study intervention was successful and we would like it to be an option offered to couples. It is important for people to have a choice of HIV prevention options that allow them to fit it into their lives,” says McGrath.

McGrath says that the other encouraging result from the study was that all the couples who decided to test for HIV together were also very keen to be screened for other health conditions that were offered.

‘Feasible and acceptable’

“We can conclude that offering a broader health screening for couples alongside HIV is feasible and acceptable, in particular, offering lab testing for sexually transmitted infections (STIs) to couples provides opportunities to treat people with STIs that have no obvious symptoms, facilitate partner treatment, and promote reproductive health,” says McGrath.

More than 7.5 million people are living with HIV in South Africa, but according to the South African National AIDS Council (SANAC), the number could be closer to 9 million. Globally, over 38 million people live with HIV.

Treatment literacy

By 2030, the UNAIDS  95-95-95 target aims to have 95 percent of people living with HIV to be aware of their status, 95 percent of those aware of their status to be on antiretroviral therapy (ART) and 95 percent of those on ART to achieve viral load suppression. South Africa is currently at 94-77-92.

Dr Chuka Onaga, Acting Chief of Party at Right to Care APACE programme says that although the country has almost achieved the first target, which is people knowing their HIV status, there is an urgent need to expand treatment literacy so that patients can understand why they should remain on their treatment.

“We need to do more around prevention services, which is a cost-effective component of the HIV response. We also need to speed up adoption of the long-acting injectable pre-exposure prophylaxis (PrEP) to prevent HIV,” says Onaga.

According to Onaga, patient health information management is another area which still needs to be improved.

“Ideally, we need a single patient information system so that a patient can go to any facility where the healthcare workers can access their clinical history. This will strengthen the management of patients across the health system,” says Onaga.

Onaga also stated that it is concerning that adolescent girls and young women are bearing the brunt of HIV, and more needs to be done to address the drivers of HIV in young women, including GBV.-Health-e News.