Relationship trajectories, trust, and couples HIV counseling and testing in rural Tanzania: Qualitative findings from NIMH project accept (HPTN 043)

Couples HIV Counseling and Testing (CHCT) has shown promise as an effective HIV prevention tool, yet rates of CHCT remain low throughout sub-Saharan Africa. To better understand low uptake of CHCT, we analyzed longitudinal qualitative data from the Tanzania site of NIMH Project Accept (HPTN 043), a multi-site community-randomized trial assessing the effectiveness of a community-based HIV prevention intervention. This analysis was restricted to women in intervention communities in relationships at baseline. We systematically coded interview transcripts with topical codes and then developed narrative summaries of the relationship trajectories and attitudes and experiences with HIV testing for each woman spanning the baseline, 15-month and 30-month interviews. Next, we developed matrices to compare the relationship and testing narratives for the participants over time. Fifteen women were identified that met our criteria and the most common patterns are represented by three illustrative cases. The cases represent 1) women who discussed their HIV results with their partners and could not convince their partners to get tested, 2) women who described “sequential” testing for HIV, where she tested first and was followed by her partner testing individually, and 3) women who originally described “concurrent” CHCT with partners as ideal within trusting relationships and later emphasized the benefits of concurrent testing within strained relationships. Our findings highlight a wide range of attitudes towards CHCT that were shaped by relationship trajectories. Strategies to increase CHCT in sub-Saharan Africa should focus on maximizing benefits of sequential CHCT and encouraging concurrent CHCT in a wide range of relationships.