A home-based counseling program for pregnant women and their male partners increased couples HIV testing and helped mothers living with HIV achieve viral suppression, new research shows.
The study, co-led by the University of Michigan and the University of Alabama at Birmingham, found that home counseling visits more than quadrupled joint HIV testing rates compared with standard clinic-based care. By 12 months postpartum, 56% of couples receiving home visits had tested together, while only 13.6% of those who received routine services at a health facility tested jointly for HIV.
The research, funded by the National Institute of Mental Health, is published in The Lancet HIV. The randomized controlled trial followed 800 couples in Kenya and evaluated approaches to increase couples HIV testing and counseling, as well as improve maternal and child health.
"Couples testing for HIV together and strengthening relationship skills can open the door to men and women collaborating to achieve optimal family health during pregnancy, postpartum and beyond," said study co-author Lynae Darbes, U-M professor of nursing. "It is also important to involve male partners in pregnancy, childbirth and postpartum care-which has been shown to be challenging."
Mother-to-child HIV transmission remains a major concern in high-prevalence settings, but early diagnosis and sustained antiretroviral therapy can greatly reduce that risk, Darbes said.
Yet, male partner engagement and couples testing often remain low because of barriers such as work-related travel, stigma, clinic settings that may not feel welcoming to men, and concerns that disclosure without adequate support could increase conflict or intimate partner violence.
"Having men involved is important, given their role in the family and in decision-making in many contexts," Darbes said. "Our results suggest that a couples-based approach can improve maternal and family health outcomes, including viral suppression for women living with HIV."
One of the study's most significant findings was improved viral suppression-an outcome closely tied to infant health-among mothers living with HIV in the home-visit group compared with those receiving standard care.
"When someone is virally suppressed, it drastically reduces the chances of transmitting HIV to a partner or fetus, and predicts better health outcomes for the person living with HIV," said study co-author Janet Turan, professor emerita at the UAB School of Public Health.
Other key findings include:
- Providing pairs of HIV self-test kits to pregnant women to use with their partners also significantly increased joint testing, with 50% of couples testing together.
- Home-based counseling was delivered by trained lay health counselors, making it a culturally sensitive and potentially low-cost approach that could be adapted more broadly.
- The home-visit approach identified more new male HIV infections and more serodifferent couples-couples in which one partner is living with HIV and the other is not-than the self-test kit approach, suggesting that home visits may provide added opportunities for diagnosis, counseling and linkage to care.
