RT Journal Article
SR Electronic
T1 Sustained effect of couples' HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples
JF Sexually Transmitted Infections
JO Sex Transm Infect
FD BMJ Publishing Group Ltd
SP 259
OP 266
DO 10.1136/sextrans-2016-052743
VO 93
IS 4
A1 Kristin M Wall
A1 William Kilembe
A1 Bellington Vwalika
A1 Lisa B Haddad
A1 Shabir Lakhi
A1 Udodirim Onwubiko
A1 Naw Htee Khu
A1 Ilene Brill
A1 Roy Chavuma
A1 Cheswa Vwalika
A1 Lawrence Mwananyanda
A1 Elwyn Chomba
A1 Joseph Mulenga
A1 Amanda Tichacek
A1 Susan Allen
YR 2017
UL http://sti.bmj.com/content/93/4/259.abstract
AB 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.