Couple-based HIV prevention and treatment: State of science, gaps, and future directions

Abstract

This chapter focuses on three areas. First, it discusses the state of science on couple-based modalities to reduce HIV risk and STIs and improve adherence to HIV treatment. Second, it discusses the potential advantages of such a modality in both HIV prevention and treatment adherence. Third, it highlights the significant gaps and limitations of couple-based HIV prevention and treatment and makes suggestions for future directions. Fourth, it examines the status of dissemination research and transportability of effective couple-based HIV prevention and treatment to real-world settings. Although advances have been made in HIV prevention science, until a short time ago, HIV prevention approaches did not adequately focus on couples. Effective couple-based intervention strategies are needed for primary prevention for serodiscordant couples, couples who do not know their HIV status, or who are both HIV negative but vulnerable. To date, few couple-focused ART adherence interventions have been tested; even though it is well established that social support is one of the most consistent correlates of adherence across a wide range of populations and diseases. So far all couple-based studies have been efficacy trials rather than effectiveness ones. It has yet to be determined whether any of the interventions is capable of widespread effectiveness under real-world conditions.