Optimising a couples-focused intervention to increase couples’ HIV testing and counselling using the person-based approach: a qualitative study in Kwa-Zulu Natal, South Africa

Abstract

ObjectivesThis qualitative study explored how to optimise a couples-focused intervention to promote couples HIV testing and counselling (CHTC).SettingCommunity setting in Kwa-Zulu Natal, South Africa.ParticipantsQualitative interviews were conducted with 20 couples who had participated in a couples-focused intervention and five staff members delivering the intervention. Partners were interviewed individually by researchers of the same gender.InterventionA couples-focused intervention comprised of two group sessions and four couples counselling sessions was previously shown to significantly increase uptake to CHTC in Kwa-Zulu Natal, South Africa. However, more than half of couples participating in the intervention still chose not to test together during follow-up.AnalysisThe transcripts were analysed using the table of changes from the person-based approach. Proposed optimisations were discussed with a community group to ensure the intervention was as persuasive and acceptable as possible.ResultsMany couples found it challenging to discuss CHTC with their partner due to an implied lack of trust. Optimisations to the intervention were identified to increase readiness to discuss CHTC, including education about serodiscordance, discussions about CHTC by peer mentors and open discussion of personal barriers to CHTC during couples’ counselling sessions. Additional training for staff in open questioning techniques could help them feel more comfortable to explore couples’ perceived barriers to CHTC, rather than advising couples to test. A logic model was developed to show anticipated mechanisms through which the optimised intervention would increase uptake to CHTC, including increasing knowledge, increasing positive outcome beliefs and managing negative emotions.ConclusionsIn-depth qualitative research informed optimisations to a couples-focused intervention for further evaluation in South Africa to encourage uptake to CHTC. Suggestions are made for optimal methods to gain open feedback on intervention experiences where participants may be reluctant to share negative views.

Psychosocial support for HIV serodiscordant couples

“…The healthcare workers provided support in the form of counselling and information giving, however, some participants felt the counselling was not person centred and not addressing issues related to HIV serodiscordancy. Related to this, Morton et al ( 2021 ) identified key barriers to engaging with couples in HIV testing services and these included concerns about trust in the relationship, lack of open discussion during counselling sessions. The authors emphasise the need for optimising couple-focused interventions…”

“…A study by Morton et al ( 2021 ) identified key barriers to engaging with couples in HIV testing services and these included concerns about trust in the relationship, lack of open discussion during counselling sessions. The authors emphasise the need for optimising couple-focused interventions…”

Protocol: evaluation of an optimised couples-focused intervention to increase testing for HIV in rural KwaZulu-Natal, South Africa, the Igugu Lethu (‘Our treasure’) cohort study

“…By strengthening communication and functioning within the relationship, both the Igugu Lethu and Uthando Lwethu studies aim to transform the motivation of individual partners from a focus on their own health to shared health as a couple [12]. The Igugu Lethu study aims to achieve a 40% higher proportion of couples testing for HIV together than the Uthando Lwethu study.…”

“…Concerned that, in a high HIV prevalence and continued HIV incidence setting [10], 58% of intervention couples did not choose to test together during the Uthando Lwethu study, we optimised the Uthando Lwethu intervention using the Person-Based Approach to intervention development and optimisation [11]. The details of the process of optimising the intervention have been published elsewhere [12]. In brief, a qualitative study was conducted with 20 purposively sampled couples who were formerly enrolled in the intervention arm of the Uthando Lwethu Study, and with 5 study staff who delivered intervention components, with the aim of exploring experiences of the intervention and barriers to testing.…”

“…The past participants sampled included couples who did not attend couples counselling sessions and did not test for HIV together, some couples who attended all couples counselling sessions and tested for HIV together during follow-up, and others who only took up part of the intervention, with or without deciding to test for HIV together. Developing guiding principles and a logic model that showed how the optimised intervention would increase uptake to CHTC ensured that optimisations were grounded in the local context and drew on theoretical constructs [12]. The optimised intervention still involves two group sessions and up to four couples' counselling sessions but differs from the Uthando Lwethu intervention in session content, involving community members speaking publicly about their HIV testing history and HIV status, and the possibility that the number of counselling sessions provided will be less if the couple engages in couples HIV testing at an earlier point in the intervention.…”