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Original article
Sustained effect of couples' HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples
  1. Kristin M Wall1,2,
  2. William Kilembe1,
  3. Bellington Vwalika1,3,
  4. Lisa B Haddad1,4,
  5. Shabir Lakhi1,3,
  6. Udodirim Onwubiko2,
  7. Naw Htee Khu1,
  8. Ilene Brill1,5,
  9. Roy Chavuma1,3,
  10. Cheswa Vwalika1,
  11. Lawrence Mwananyanda1,
  12. Elwyn Chomba1,6,
  13. Joseph Mulenga1,
  14. Amanda Tichacek1,
  15. Susan Allen1
  1. 1Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  2. 2Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
  3. 3Department of Gynaecology and Obstetrics (BV), Internal Medicine (SL) and Surgery (RC), School of Medicine, University of Zambia, Lusaka, Zambia
  4. 4Department of Gynaecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia, USA
  5. 5Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
  6. 6Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
  1. Correspondence to Dr Kristin M Wall, 1518 Clifton Road NE, Atlanta, GA 30322, USA; kmwall{at}emory.edu

Abstract

Background We present temporal trends in self-reported and biological markers of unprotected sex and sex with concurrent partners in discordant couples receiving couples' voluntary HIV counselling and testing (CVCT).

Methods Heterosexual Zambian HIV-serodiscordant couples were enrolled into longitudinal follow-up in an open cohort (1994–2012). Multivariable Anderson-Gill models explored predictors of self-report and biological indicators of unprotected sex within (including sperm on a vaginal swab, incident pregnancy or incident linked HIV infection) and outside (including self-report, STI and unlinked HIV infection) the union. Measures of secular trends in baseline measures were also examined.

Results At enrolment of 3049 couples, men were 35 years old on average, women were 29 years, and couples had been together for an average of 7 years. M+F− couples reported an average of 16.6 unprotected sex acts in the 3 months prior to enrolment (pre-CVCT), dropping to 5.3 in the >0–3 month interval, and 2.0 in >6 month intervals (p-trend <0.001). Corresponding values for M−F+ couples were 22.4 unprotected sex acts in the 3 months prior enrolment, dropping to 5.2 in the >0–3 month interval, and 3.1 in >6 month intervals (p-trend <0.001). Significant reductions in self-report and biological markers of outside partners were also noted. Predictors of unprotected sex between study partners after CVCT included prevalent pregnancy (adjusted HR, aHR=1.6–1.9); HIV+ men being circumcised (aHR=1.2); and HIV− women reporting sex with outside partners (aHR=1.3), alcohol (aHR=1.2), injectable (aHR=1.4) or oral (aHR=1.4) contraception use. Fertility intentions were also predictive of unprotected sex (aHR=1.2–1.4). Secular trends indicated steady declines in reported outside partners and STIs.

Conclusion Reductions in self-reported unprotected sex after CVCT were substantial and sustained. Reinforced risk-reduction counselling in pregnant couples, couples desiring children and couples with HIV− women having outside partners or using alcohol or injectable or oral contraception are indicated.

  • AFRICA
  • AIDS
  • BEHAVIOURAL INTERVENTIONS
  • EPIDEMIOLOGY (GENERAL)
  • SEXUAL BEHAVIOUR

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Handling editor Jackie A Cassell

  • Contributors KMW and LBH contributed to the analysis and interpretation of data, drafted the article and revised it critically for important intellectual content, and gave final approval of the version to be published. WK, BV, SL, RC, CV, LM, EC and JM contributed to the conception and design of the study, revised the article critically for important intellectual content, and gave final approval of the version to be published. UO, NHK, IB and AT contributed to the study conception and design, revised the article critically for important intellectual content, and gave final approval of the version to be published. SA contributed to the study design and conception, contributed to the analysis and interpretation of data, revised the article critically for important intellectual content and gave final approval of the version to be published.

  • Competing interests This research was conducted with funding from NICHD R01-40125, NIAID R01-23980 and R01-40951 and R21-33863, NIMH R01-46571, R01-66767, and R01-95503; the Fogarty AIDS International Training in Research Program (AITRP) FIC D43 TW001042, NIH Centers for AIDS Research, the Social & Behavioral Science Core of the Emory Center for AIDS Research (CFAR) P30 AI050409; the US Centers for Disease Control and Prevention (5U2GPS000758) and the International AIDS Vaccine Initiative. This study was made possible by the generous support of the American people through the US Agency for International Development (USAID). The contents do not necessarily reflect the views of USAID or the US Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Funding US Agency for International Development (International AIDS Vaccine Initiative, National Institutes of Health (NICHD R01 HD40125; NIMH R01 66767; D43 TW001042; P), Centers for Disease Control and Prevention (5U2GPS000758).

  • Ethics approval Emory University and Zambian IRBs.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The dataset may be eligible to be added to a public repository.

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