Background This systematic review and meta-analysis aimed to estimate and characterise the uptake of Couples HIV Testing and Counselling (CHTC) in Sub-Saharan African countries.

Methods A comprehensive search of published studies was carried out in six electronic databases followed by a manual search of studies from references of selected papers. Data were extracted using a template. The results were synthesised, and a meta-analysis based on a random-effects model was conducted. Subgroup and sensitivity analyses were undertaken to explore sources of heterogeneity.

Results Of 30,273 citations, 14 studies with a total of 97,030 study participants were identified. The pooled CHTC uptake was 31.48% (95%CI: 23.55–40.00) with significant heterogeneity between studies (I²=99.98%, p < 0.001). The Egger’s and Begg’s tests showed there was no evidence of publication bias (p=0.08). However, the sensitivity analysis showed that two studies highly influenced the overall estimate. After omitting these two studies, the pooled estimate for CHTC uptake was 24.05% (95%CI: 16.6 5, 32.34, I²=99.86%, p<0.001). The sub-group analysis indicated the pooled CHTC uptake was higher among pregnant women and their partners (OR=1.66, 95%CI: 1.58, 1.84) compared with heterosexual couples in general. Similarly, the uptake was higher when one person in the dyad first tested individually without the knowledge of their partner, and then suggested to their partner that they take CHTC together, compared to an approach of undertaking CHTC together as the first testing option for both people (OR=3.16, 95%CI: 2.69, 3.72).

Conclusion The findings confirmed that more than three-quarters of study participants who were in ongoing heterosexual relationships chose not to, or were unable to, undertake CHTC. These findings suggest people are cautious of what could amount to harmful risks when couples test together, particularly if their HIV sero-status is shown to be discordant. Further studies are required to explore how couples intend to use HIV testing services including CHTC.

Disclosure No significant relationships.