Heterosexual couples' attitudes and associated factors of couple's HIV testing and counseling

夫妇艾滋病毒检测和咨询（CHTC，称为共同检测）需要夫妇双方的合作伙伴 接受咨询，进行艾滋病毒/性传播感染检测，并一起获得检测结果。大多数研究涉及 在美国，已经开展了以异性恋伴侣为基础的艾滋病毒风险降低干预措施，包括CHTC， 具有特定的子组（例如，吸毒者）和/或发生在特定位置（例如，美沙酮诊所）。 虽然这些项目已证明在减少艾滋病毒风险方面的有效性， CHTC捕捉更广泛的混合性伴侣是至关重要的，因为异性性传播帐户 美国25%的新艾滋病毒感染者。因此，需要进行更多的研究，以确定障碍， 促进者的CHTC吸收之间的混合性别的夫妇。为更多和更广泛的客户提供CHTC 夫妇将有助于增加对血清不一致二对的识别，将新诊断的伴侣与艾滋病毒护理联系起来， 和治疗，并促进采用其他初级预防战略（例如，避孕套、PrEP） 艾滋病毒检测结果呈阴性的人。CHTC还使夫妇能够制定降低风险的策略 根据他们的联合艾滋病毒检测结果，以及性健康和关系偏好。但执行 还必须考虑艾滋病毒检测咨询师的培训需求， 在美国的混合性伴侣。因此，我们建议进行一个新的，混合的方法，为期两年的项目， 全国范围内的300对混合性别的夫妇，25名艾滋病毒检测顾问谁提供CHTC，以及25 未经训练/幼稚的CHTC艾滋病毒检测顾问。所有研究活动都将通过既定的 通过使用符合HIPAA标准的Web服务器、调查软件和视频门户网站，由一个既有 PI，团队的专业知识包括定性，定量和混合方法，二元数据分析，在线 研究，CHTC，和艾滋病毒相关的风险行为，辅以必要的工作经验， 夫妇和艾滋病毒检测提供者。开始，我们将进行一次全国性的横断面调查， 来自300对混合性别夫妇的定量二元数据，以评估他们使用CHTC的意愿和相关的 因素（目标1）。我们假设，夫妇将分为3组，是否都没有，或只有一个 伙伴（即，不一致）愿意使用CHTC。在这300对夫妇中，我们将随机选出30对 夫妇进行定性访谈，从这3个组中的每一个平等的代表，以探讨和 将他们感知到的使用CHTC的障碍和促进因素置于情境中;双方都将接受采访 同时和单独（目标2）。最后，我们将对50名艾滋病病毒检测者进行定性访谈 辅导员（25名提供CHTC，25名未经培训）检查和确定他们的实施和培训需求， 为更多的混合性别夫妇提供家庭健康中心（目标3）。我们的发现将有助于确定 需要艾滋病毒检测咨询师的实施和培训需求，以及增加 愿意使用CHTC，以实现在美国更多的混合性别夫妇中更大的CHTC吸收。

Couples HIV testing and counseling (CHTC, known as Testing Together) entails both partners of the couple receive counseling, test for HIV/STIs, and obtain their test results together. The majority of studies involving heterosexual couple-based HIV risk reduction interventions in the US, including CHTC, have been conducted with specific subgroups (e.g., drug-users) and/or occurred in a specific location (e.g., methadone clinics). Although these projects have demonstrated effectiveness for reducing HIV risk, implementation and uptake of CHTC to capture a wider range of mixed-sex couples is critical as heterosexual sexual transmission accounts for 25% of new HIV infections in the US. As such, additional research is needed to identify barriers and facilitators of CHTC uptake among mixed-sex couples. Offering CHTC to a larger number and wider range of couples would help increase identification of serodiscordant dyads, link newly diagnosed partners to HIV care and treatment, and promote the uptake of other primary prevention strategies (e.g., condoms, PrEP) among those who receive a HIV-negative test result. CHTC also enables couples to create a risk-reduction strategy based on their joint HIV test results, and sexual health and relational preferences. However, implementation and training needs of HIV test counselors must also be considered to increase uptake of CHTC among more mixed-sex couples in the US. Thereby, we propose to conduct a novel, mixed method, two-year project with a nation-wide sample of 300 mixed-sex couples, and 25 HIV test counselors who provide CHTC, as well as 25 HIV test counselors who are CHTC untrained/naïve. All study activities will occur online through established protocols by using HIPAA-compliant web servers, survey software, and video portals. Led by an established PI, expertise of the team includes qualitative, quantitative, and mixed methods, dyadic data analysis, online research, CHTC, and HIV risk-related behaviors, complemented with the necessary experience of working with couples and HIV test providers. To begin, we will conduct a nation-wide, cross sectional survey to collect quantitative dyadic data from 300 mixed-sex couples to assess their willingness to use CHTC and associated factors (Aim 1). We hypothesize that couples will fall into 3 groups on whether both, neither, or only one partner (i.e., discrepant) is willing to use CHTC. Among these 300 couples, we will then randomly select 30 couples to conduct qualitative interviews with equal representation from each of these 3 groups to explore and contextualize their perceived barriers and facilitators toward using CHTC; both partners will be interviewed separately and simultaneously (Aim 2). Finally, we will conduct qualitative interviews with 50 HIV test counselors (25 provide CHTC, 25 untrained) to examine and identify their implementation and training needs to provide CHTC to more mixed-sex couples (Aim 3). Our findings will help identify what additional implementation and training needs are required for HIV test counselors, as well as the strategies to increase willingness to use CHTC to achieve greater uptake of CHTC among more mixed-sex couples in the US.