Onyango, O.A., Grace, J.-S., James, K., et al. AIDS (August 2013), E-publication ahead of print.
The authors implemented a randomized, single-blind clinical trial in Nyanza Province, Kenya, to compare the accessibility and uptake of couples HIV testing and counseling (HTC) by male partners during home visits versus appointments at antenatal care (ANC) clinics. Home visits reached and tested at least twice as many partners, and identified and referred more HIV-positive men, compared with the clinic group. Pregnant women seeking ANC were randomized to receive home visits for couples HTC (n=150) or to invite their male partner to the clinic (n=150); 128 (85 percent of those reached) and 54 (36 percent of those reached) male partners underwent couples HTC at homes and the clinic, respectively. Couples were significantly more likely to learn that they were concordant negative tested at home (66 percent) rather than at the clinic (26 percent); yet home-visit couples were also three times more likely to be HIV-serodiscordant. Women whose partners were tested at home were more likely to report improved quality in the relationship (67 to 28 percent). Long-term studies are needed to monitor relationship outcomes. Home HTC visits were highly acceptable for couples, which may lessen barriers to reaching male partners. The authors concluded that the home visit strategy for couples HTC during pregnancy may achieve public health impact and increase uptake of prevention of mother-to-child transmission services in high-prevalence and low-income settings.