HIV prevention and care for couples in South Africa

项目总结/摘要 南非仍然是受艾滋病毒流行影响最严重的国家之一， 在产前诊所就诊的女性中，成人艾滋病毒感染率估计为18%至30%。现在有 大量证据表明，80%以上的新感染发生在主要的男女伴侣关系中。 初级伴侣中新感染率高的原因是， 艾滋病毒检测和外部性伙伴的高流行率。Darbes（MPI）最近在夸祖鲁-纳塔尔的工作 (KZN)这项新研究的发起者发现，在330对异性恋夫妇中， 的男性和41%的女性以前没有HIV检测史。在20%的夫妇中， 尽管生活在全球成人艾滋病毒流行率最高的地区之一，超越低谷 尽管艾滋病毒检测水平较低，但最近的工作还表明，南方的整个护理过程存在显着缺陷 非洲：哈伯最近在KZN的工作表明，只有45%的艾滋病毒阳性者与护理有关，35%的人与护理有关。 启动ART，33%达到病毒抑制。有越来越多的证据表明，夫妇集中艾滋病毒的有效性 预防干预。夫妇艾滋病毒检测和咨询（CHTC）是一个行之有效的战略，以减少风险 艾滋病病毒在伴侣之间的传播。然而，CHTC只关注艾滋病毒级联的第一阶段 护理-检测-没有任何干预措施，使夫妇能够一起通过护理级联。 我们采用随机对照试验设计，对272对夫妇进行研究，旨在解决艾滋病预防和治疗方面的这一差距， 护理文献，通过比较一套双重点艾滋病毒检测和咨询干预措施， 注意力匹配控制。拟议的随机对照试验将测试二元干预的有效性， 在抑制病毒和参与艾滋病毒护理方面取得进展。异性恋夫妇代表了一个重要的，但超过- 南非的风险群体，迫切需要创新的解决方案来改善整个 艾滋病护理的连续性。

PROJECT SUMMARY/ABSTRACT South Africa remains one of the countries mostly heavily impacted by the HIV epidemic, with an overall estimated adult HIV prevalence of 18% to 30% among female antenatal clinic attendees. There is now substantial evidence that more than 80% of new infections occur within primary male-female partnerships. The high rates of new infections among primary partnerships are attributed to a combination of low levels of HIV testing and a high prevalence of outside sex partners. Recent work by Darbes (MPI), in KwaZulu-Natal (KZN) – the site of the proposed new research – found that among a sample of 330 heterosexual couples, 49% of men and 41% of women had no previous HIV testing history. In 20% of couples, neither partner had ever tested for HIV, despite living in a region with one of the highest adult HIV prevalence globally. Beyond the low levels of HIV testing, recent work also demonstrates significant deficits across the continuum of care in South Africa: recent work by Haber in KZN shows that only 45% of HIV-positive individuals are linked to care, 35% initiate ART, and 33% reach viral suppression. There is increasing evidence of efficacy for couples' focused HIV prevention interventions. Couples HIV Testing and Counseling (CHTC) is a proven strategy to reduce the risk of HIV transmission between partners. However, CHTC focuses only on the first stage of the cascade of HIV care – testing – are there are no interventions that allow couples to pass through the cascade of care together. Using a randomized controlled trial design with 272 couples, we aim to address this gap in HIV prevention and care literature by comparing a package of dyadic focused HIV testing and counseling interventions, against an attention matched control. The proposed RCT will test the efficacy of the dyadic intervention for achieving gains in viral suppression and engagement in HIV care. Heterosexual couples represent a significant yet over- looked risk group in South Africa, and innovative solutions are urgently needed to improve progression across the continuum of HIV care.