Janet M. Turan, Ph.D.A new study co-led by researchers at the University of Alabama at Birmingham and the University of Michigan demonstrates that engaging both partners during pregnancy, rather than focusing solely on expectant mothers, can significantly improve HIV prevention and treatment outcomes for families.
Published in The Lancet HIV, the randomized controlled trial followed 800 couples in Kenya and evaluated innovative approaches to increase couples HIV testing and counseling and improve maternal and child health.
The study found that home-based counseling sessions delivered to couples more than quadrupled joint HIV testing rates compared to standard clinic-based care. By 12 months postpartum, 56.2 percent of couples receiving home visits had tested together, compared to just 13.6 percent receiving routine services.
“Working together with both members of a couple is critical for achieving successful HIV prevention and treatment,” said Janet M. Turan, Ph.D., professor emerita of Health Policy and Organization in the UAB School of Public Health.
Why couples matter
Pregnancy represents a critical opportunity to prevent HIV transmission to both infants and partners, yet many programs focus exclusively on women, overlooking the importance of engaging both individuals in a relationship.
“It is crucially important to implement treatment and prevention strategies for pregnant women to prevent the spread of HIV to their infants and partners, as well as to promote positive outcomes in women living with HIV and prevent women who are not living with HIV from becoming infected,” Turan said. “To optimize these efforts, it is important for both partners of a couple to know their HIV status and have mutual disclosure, which can be accomplished through Couples HIV Testing and Counseling.”
However, she noted that “many programs focus on the pregnant woman alone,” limiting opportunities to improve outcomes across the family.
“Couples testing for HIV together and strengthening couple relationship skills can open the door to men and women collaborating to achieve optimal family health during pregnancy, postpartum and beyond,” Turan added. “It is also beneficial to involve male partners in the process of pregnancy, childbirth and postpartum care — which has been shown to be challenging.”
Improving maternal health and protecting infants
One of the most significant findings was improved viral suppression among mothers living with HIV in the home-visit group — an outcome closely tied to infant health.
“When someone is virally suppressed, it drastically reduces the chances of transmitting HIV to a partner or fetus, and predicts better health outcomes for the person living with HIV,” Turan said. “If a pregnant woman living with HIV is virally suppressed, the chances of her transmitting the virus to her infant are less than 1 percent.”
Among women living with HIV, those in the home-visit group achieved the highest levels of viral suppression compared to standard care.
Two promising, scalable solutions
In addition to home-based counseling, the study evaluated the use of HIV self-test kits for couples. This approach also significantly increased joint testing, with 50 percent of couples testing together.
“We also found that providing pairs of HIV self-test kits to pregnant women to use together with her male partner resulted in a significantly higher percentage of couples testing together,” Turan said. “This is another low-cost couple-focused strategy that may be used to increase rates of couples testing together for HIV.”
The home-based sessions were delivered by trained lay health counselors — non-clinicians who conducted joint visits with couples in their homes.
“Lay health counselors are non-clinicians who are widely available in many low-resource settings and who can deliver such interventions in a way that is culturally sensitive and low-cost,” Turan said.
A shift toward family-centered care
The findings point to the need for a broader shift toward family-centered approaches in HIV prevention and maternal care.
“Utilizing couple home visits to strengthen relationship skills and engage both partners around HIV prevention and family health during pregnancy is a promising strategy for increased couple HIV testing and viral suppression,” Turan said.
The researchers emphasize that incorporating couple-focused strategies into routine maternal health services could help improve outcomes for women, infants and families worldwide.
Lynae Darbes, professor in the University of Michigan School of Nursing served as co-author of the study with Turan.