Rosenberg Nora E, Graybill Lauren A, Mtande Tiwonge, McGrath Nuala, Maman Suzanne, Nthani Tiyamike, Krysiak Robert, Thengolose Isaac, Hoffman Irving F, Miller William C, Hosseinipour Mina
Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC.
UNC Project-Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi.
J Acquir Immune Defic Syndr. 2025 Apr 1;98(4):386-394. doi: 10.1097/QAI.0000000000003583. Epub 2025 Feb 19.
Couple-based behavioral interventions (CBIs) have been associated with improved HIV virological outcomes for pregnant women and their male partners living with HIV in observational settings, but have never been tested in a randomized controlled trial (RCT).
Bwaila District Hospital Antenatal Clinic (Lilongwe, Malawi).
An RCT was conducted among 500 pregnant women living with HIV (index clients) randomized 1:1 to the standard of care (SOC) or CBI and followed for 1 year. The CBI offered an initial session for index clients, HIV-assisted partner notification, 2 enhanced couple counseling and testing sessions, illustrated materials, and antiretroviral therapy pickup for either couple member at the antenatal clinic. At 12 months, viral load among index clients and male partners with HIV was measured. Risk differences (RD) and 95% confidence intervals (CIs) compared viral suppression (<1000 copies/mL) between arms.
The mean index client age was 26.6 years; most were married or cohabiting (93.3%). Index client viral suppression was 6.5% higher in the CBI arm (88.0%) than in the SOC arm (81.6%). Male partner viral suppression was 16.2% higher in the CBI arm (73.6%) than the SOC arm (57.4%). Overall, couple viral suppression was 7.8% higher (CI: 0.5% to 15.1%, P = 0.04) in the CBI arm (84%) than in the SOC arm (76.0%). Social harms were rare (3.6%) and comparable between arms ( P = 0.8).
This CBI had a positive impact on couple viral suppression. Scaling this CBI to antenatal clients with HIV and their male partners could improve HIV outcomes among expecting families.
在观察性研究中，基于夫妻的行为干预措施（CBIs）与感染艾滋病毒的孕妇及其男性伴侣改善艾滋病毒病毒学结果相关，但从未在随机对照试验（RCT）中进行过测试。
布瓦伊拉区医院产前诊所（马拉维利隆圭）。
对500名感染艾滋病毒的孕妇（索引客户）进行了一项随机对照试验，她们被1:1随机分配到标准护理（SOC）组或CBIs组，并随访1年。CBIs为索引客户提供了初始疗程、艾滋病毒辅助伴侣通知、2次强化夫妻咨询和检测疗程、图文资料，以及为夫妻双方中的任何一方在产前诊所领取抗逆转录病毒疗法药物。在12个月时，对索引客户和感染艾滋病毒的男性伴侣的病毒载量进行了测量。风险差异（RD）和95%置信区间（CIs）比较了两组之间的病毒抑制情况（<1000拷贝/毫升）。
索引客户的平均年龄为26.6岁；大多数人已婚或同居（93.3%）。CBIs组的索引客户病毒抑制率（88.0%）比SOC组（81.6%）高6.5%。CBIs组的男性伴侣病毒抑制率（73.6%）比SOC组（57.4%）高16.2%。总体而言，CBIs组的夫妻病毒抑制率（84%）比SOC组（76.0%）高7.8%（CI：0.5%至15.1%，P = 0.04）。社会危害很少见（3.6%），且两组之间相当（P = 0.8）。
这种CBIs对夫妻病毒抑制有积极影响。将这种CBIs推广到感染艾滋病毒的产前客户及其男性伴侣中，可以改善准家庭的艾滋病毒感染状况。
