Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Charleston, SC, USA.
Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
BMC Public Health. 2021 Apr 14;21(1):720. doi: 10.1186/s12889-021-10707-x.
A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART.
This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples' HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples' decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis.
Three major themes were identified: (1) HIV as "two people's secret" and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention.
The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.
撒哈拉以南非洲地区相当数量的新感染艾滋病毒病例发生在稳定的伴侣中。生物医学预防（暴露前预防，PrEP）和治疗（抗逆转录病毒疗法，ART）可以使性伴侣受益，并可用于预防艾滋病毒血清不一致的伴侣之间的感染。然而，研究通常侧重于个人，而不是对偶，即使干预措施可能直接或间接地影响性伴侣。在涉及艾滋病毒预防和治疗的异性血清不一致伴侣的研究中，在招募、知情同意和干预措施实施方面，仍存在最佳实践方面的差距。这项定性研究旨在了解和描述血清不一致的伴侣在以下方面的决策和对偶层面的影响：（1）参与涉及艾滋病毒自我检测和获得 PrEP 的基于对偶的研究；（2）使用 PrEP 和 ART。
这项定性研究嵌套在一个观察性队列研究中，该研究评估了家庭为基础的伴侣艾滋病毒自我检测的可接受性，以及涉及为艾滋病毒阳性伴侣提供便利转诊和为艾滋病毒阴性伴侣提供 PrEP 以获得对偶护理的血清不一致伴侣的接受程度。对一小部分研究参与者（n=22）以及选择不参与研究的血清不一致关系的个人（n=9）进行了半结构化深入访谈。访谈重点是关于研究参与的夫妇决策和药物使用的对偶层面的影响。访谈记录被逐字转录并从斯瓦希里语翻译成英语。使用主题分析进行数据分析。
确定了三个主要主题：（1）艾滋病毒是“两个人的秘密”，伴侣支持在血清不一致关系中的作用提升；（2）艾滋病毒状况和性别在决策中的交叉作用；（3）PrEP 的关系效益，包括对夫妇的心理社会效益，超出了预防范围。
研究发现，夫妇共同决定参与研究和接受与艾滋病毒相关的药物治疗。在涉及艾滋病毒血清不一致伴侣的研究和项目中，应考虑关系自主权和对偶层面的影响。
