A meta-analysis of couple-focused interventions to promote HIV prevention, 1988-2013

Background/Objective:  To conduct a systematic review and meta-analysis of HIV behavioral interventions focused on or delivered to sexually intimate heterosexual or same-sex couples and assess their efficacy in promoting HIV prevention behaviors.

Methods:  We conducted automated searches of electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL) from January 1988 to April 2013, and manual searches of journals, reference lists, and listservs.  Studies were eligible if they were controlled trials or prospective cohort designs, evaluated a couple-focused HIV prevention intervention, assessed at least one HIV prevention outcome (e.g., sex or drug use behavior, HIV testing, HIV treatment behaviors, STD infection), and reported data sufficient for calculating effect sizes (ES).

Results: A total of 19 studies were reviewed. Overall, participants in couple-focused interventions, relative to those in any comparison group, were significantly more likely to report consistent condom use (OR=1.63, 95% CI=1.05, 2.51; 9 ES) and less likely to report sex without a condom (OR=0.49, 95% CI=0.39, 0.83; 11 ES). Only 3 studies reported effects on HIV testing among pregnant women and results were not significant but in the favorable direction (OR=2.42, 95% CI=0.92, 6.40; p=.09). However, couple-based interventions showed a significantly positive effect on nevirapine uptake among HIV-positive pregnant women (OR=1.51, 95% CI=1.02, 2.24; 6 ES).

Conclusions/Implications: Our findings demonstrated that couple-based interventions can be effective in reducing HIV sex risk behaviors and promoting HIV treatment uptake. Incorporating couple-focused interventions into programs targeting populations most at risk is likely to maximize prevention effects on reducing HIV transmission among couples and also mother-to-child transmission.