Are couple-based interventions more effective than interventions delivered to individuals in promoting HIV protective behaviors? A meta-analysis

ABSTRACT

Despite several advantages to bringing couples together to learn how to protect themselves and new-born children from the risk of HIV infection, most interventions are designed for individuals or groups, not for dyads. This meta-analysis provides a direct test of whether couple-based interventions are more effective in promoting HIV protective behaviors than interventions delivered to individuals. We conducted systematic searches of five electronic databases and 60 journals. Eligible studies were controlled trials or prospective cohort designs; evaluated a couple-based intervention compared to an individual-level intervention; assessed at least one HIV prevention outcome (e.g., protective sex, drug use, HIV testing, medication adherence, and sexually transmitted infections [STI]); and were published between 1988 and 2014. Fifteen interventions, including 21,882 participants from China, Kenya, Rwanda, Tanzania, Trinidad, Zambia, and the USA, were evaluated. The results of random-effects models showed statistically significant intervention effects for protective sex (OR = 1.60, 95% CI = 1.21, 2.11), HIV testing (OR = 1.79, 95% CI = 1.31, 2.45), and Nevirapine uptake (OR = 1.51, 95% CI = 1.02, 2.24). The evidence demonstrates the usefulness of couple-based interventions in protecting individuals, partners, and new-born children from the risk of HIV transmission and infection.

KEYWORDS:

• HIV prevention
• couple-based
• systematic review
• meta-analysis
• intervention

Acknowledgements

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention. We thank other members of the HIV/AIDS Prevention Research Synthesis (PRS) Project members for their contribution to the coding and maintenance of the PRS database that was used for this systematic review (listed alphabetically): Adebukola Adegbite, Terrika Barham, Julia B. DeLuca, Darrel Higa, Linda Kay (former), Theresa A. Sipe, and Christina White.

Contributors: N Crepaz originated the study and was responsible for writing the brief. MV Tungol-Ashmon, HW Vosburgh, BN Baack, and MM Mullins did data coding, conducted analyses, and provided technical and material support, article review and editing.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This work was supported by the Division of HIV/AIDS Prevention at the U.S. Centers for Disease Control and Prevention and was not funded by any other organization.