Becker Stan, Taulo Frank O, Hindin Michelle J, Chipeta Effie K, Loll Dana, Tsui Amy
Population, Family and Reproductive Health Department, Johns Hopkins School of Public Health, 615 N, Wolfe St,, Baltimore, Md 21205, USA.
BMC Public Health. 2014 Dec 20;14:1309. doi: 10.1186/1471-2458-14-1309.
HIV counseling and testing for couples is an important component of HIV prevention strategies, particularly in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors.
This study involved offering CHCT and CFP services to couples in their homes; 180 couples were sampled from households in a peri-urban area of Blantyre. Baseline data were collected from both partners and follow-up data were collected one week later. A pair of male and female counselors approached each partner separately about HIV testing and counseling and contraceptive services and then, if both consented, CHCT and CFP services (pills, condoms and referrals for other methods) were given. Bivariate and multivariate logistic regression analyses were done to examine the relationship between individual partner characteristics and acceptance of the services. Selected behaviors reported pre- and post-intervention, particularly couple reports on contraceptive use and condom use at last sex, were also tested for differences.
89% of couples accepted at least one of the services (58% CHCT-only, 29% CHCT + CFP, 2% CFP-only). Among women, prior testing experience (p < 0.05), parity (p < 0.01), and emotional closeness to partner (p < 0.01) had significant bivariate associations with acceptance of at least one service. Reported condom use at last sex increased from 6% to 25% among couples receiving any intervention. First-ever HIV testing was delivered to 25 women and 69 men, resulting, respectively, in 4 and 11 newly detected infections.
Home-based CHCT and CFP were very successful in this pilot study with high proportions of previously untested husbands and wives accepting CHCT and there were virtually no negative outcomes within one week. This study supports the need for further research and testing of home- and couple-based approaches to expand access to HCT and contraceptive services to prevent the undesired consequences of sexually transmitted infection and unintended pregnancy via unprotected sex.
为配偶提供艾滋病毒咨询和检测是艾滋病毒预防策略的重要组成部分，在撒哈拉以南非洲地区尤为如此。这项试点研究的目的是评估马拉维城郊地区单次家访中配偶艾滋病毒咨询和检测（CHCT）及配偶计划生育（CFP）服务的接受情况，并评估相关因素。
本研究包括为配偶在家中提供CHCT和CFP服务；从布兰太尔城郊地区的家庭中抽取了180对配偶。从夫妻双方收集基线数据，并在一周后收集随访数据。一对男女咨询师分别向每位配偶询问艾滋病毒检测、咨询及避孕服务情况，若双方均同意，则提供CHCT和CFP服务（避孕药、避孕套及其他方法的转诊）。进行双变量和多变量逻辑回归分析，以检验个体配偶特征与服务接受情况之间的关系。还对干预前后报告的特定行为进行了测试，特别是夫妻双方关于上次性行为时避孕措施使用和避孕套使用情况的报告差异。
89%的配偶接受了至少一项服务（仅接受CHCT的占58%，接受CHCT + CFP的占29%，仅接受CFP的占2%）。在女性中，既往检测经历（p < 0.05）、产次（p < 0.01）以及与配偶的情感亲密度（p < 0.01）与接受至少一项服务存在显著的双变量关联。在接受任何干预的夫妻中，报告的上次性行为时避孕套使用率从6%增至25%。首次为25名女性和69名男性进行了艾滋病毒检测，分别新发现4例和11例感染。
在这项试点研究中，基于家庭的CHCT和CFP非常成功，此前未检测的夫妻中很大比例接受了CHCT，且一周内几乎没有负面结果。本研究支持进一步开展基于家庭和配偶的方法的研究与测试，以扩大艾滋病毒检测和避孕服务的可及性，预防通过无保护性行为导致的性传播感染和意外怀孕的不良后果。
