Sustained effect of couples' HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples. (12th January 2017)

• Record Type: Journal Article
• Authors: Wall, Kristin M; Kilembe, William; Vwalika, Bellington; Haddad, Lisa B; Lakhi, Shabir; Onwubiko, Udodirim; Htee Khu, Naw; Brill, Ilene; Chavuma, Roy; Vwalika, Cheswa; Mwananyanda, Lawrence; Chomba, Elwyn; Mulenga, Joseph; Tichacek, Amanda; Allen, Susan
• Is Part Of: Sexually transmitted infections. Volume 93(2017)Supplement 4
• Page Start: 259
• Page End: 266
• Publication Date: 2017-01-12
• Subjects: AFRICA -- AIDS -- BEHAVIOURAL INTERVENTIONS -- EPIDEMIOLOGY (GENERAL) -- SEXUAL BEHAVIOUR; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2016-052743
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Background: We present temporal trends in self-reported and biological markers of unprotected sex and sex with concurrent partners in discordant couples receiving couples' voluntary HIV counselling and testing (CVCT). Methods: Heterosexual Zambian HIV-serodiscordant couples were enrolled into longitudinal follow-up in an open cohort (1994–2012). Multivariable Anderson-Gill models explored predictors of self-report and biological indicators of unprotected sex within (including sperm on a vaginal swab, incident pregnancy or incident linked HIV infection) and outside (including self-report, STI and unlinked HIV infection) the union. Measures of secular trends in baseline measures were also examined. Results: At enrolment of 3049 couples, men were 35 years old on average, women were 29 years, and couples had been together for an average of 7 years. M+F− couples reported an average of 16.6 unprotected sex acts in the 3 months prior to enrolment (pre-CVCT), dropping to 5.3 in the >0–3 month interval, and 2.0 in >6 month intervals (p-trend <0.001). Corresponding values for M−F+ couples were 22.4 unprotected sex acts in the 3 months prior enrolment, dropping to 5.2 in the >0–3 month interval, and 3.1 in >6 month intervals (p-trend <0.001). Significant reductions in self-report and biological markers of outside partners were also noted. Predictors of unprotected sex between study partners after CVCT included prevalent pregnancy (adjusted HR, aHR=1.6–1.9); HIV+ men being circumcised (aHR=1.2); and HIV− women reporting sex with outside partners (aHR=1.3), alcohol (aHR=1.2), injectable (aHR=1.4) or oral (aHR=1.4) contraception use. Fertility intentions were also predictive of unprotected sex (aHR=1.2–1.4). Secular trends indicated steady declines in reported outside partners and STIs. Conclusion: Reductions in self-reported unprotected sex after CVCT were substantial and sustained. Reinforced risk-reduction counselling in pregnant couples, couples desiring children and couples with HIV− women having outside partners or using alcohol or injectable or oral contraception are indicated.