Couples HIV testing and counseling (CHTC, known as Testing Together) entails both partners of the couple receive counseling, test for HIV/STIs, and obtain their test results together. The majority of studies involving heterosexual couple-based HIV risk reduction interventions in the US, including CHTC, have been conducted with specific subgroups (e.g., drug-users) and/or occurred in a specific location (e.g., methadone clinics). Although these projects have demonstrated effectiveness for reducing HIV risk, implementation and uptake of CHTC to capture a wider range of mixed-sex couples is critical as heterosexual sexual transmission accounts for 25% of new HIV infections in the US. As such, additional research is needed to identify barriers and facilitators of CHTC uptake among mixed-sex couples. Offering CHTC to a larger number and wider range of couples would help increase identification of serodiscordant dyads, link newly diagnosed partners to HIV care and treatment, and promote the uptake of other primary prevention strategies (e.g., condoms, PrEP) among those who receive a HIV-negative test result. CHTC also enables couples to create a risk-reduction strategy based on their joint HIV test results, and sexual health and relational preferences. However, implementation and training needs of HIV test counselors must also be considered to increase uptake of CHTC among more mixed-sex couples in the US. Thereby, we propose to conduct a novel, mixed method, two-year project with a nation-wide sample of 300 mixed-sex couples, and 25 HIV test counselors who provide CHTC, as well as 25 HIV test counselors who are CHTC untrained/nave. All study activities will occur online through established protocols by using HIPAA-compliant web servers, survey software, and video portals. Led by an established PI, expertise of the team includes qualitative, quantitative, and mixed methods, dyadic data analysis, online research, CHTC, and HIV risk-related behaviors, complemented with the necessary experience of working with couples and HIV test providers. To begin, we will conduct a nation-wide, cross sectional survey to collect quantitative dyadic data from 300 mixed-sex couples to assess their willingness to use CHTC and associated factors (Aim 1). We hypothesize that couples will fall into 3 groups on whether both, neither, or only one partner (i.e., discrepant) is willing to use CHTC. Among these 300 couples, we will then randomly select 30 couples to conduct qualitative interviews with equal representation from each of these 3 groups to explore and contextualize their perceived barriers and facilitators toward using CHTC; both partners will be interviewed separately and simultaneously (Aim 2). Finally, we will conduct qualitative interviews with 50 HIV test counselors (25 provide CHTC, 25 untrained) to examine and identify their implementation and training needs to provide CHTC to more mixed-sex couples (Aim 3). Our findings will help identify what additional implementation and training needs are required for HIV test counselors, as well as the strategies to increase willingness to use CHTC to achieve greater uptake of CHTC among more mixed-sex couples in the US.
This high risk, high reward R21 proposal seeks to identify and characterize factors associated with mixed- sex couples' willingness to use couples HIV testing and counseling (CHTC) in the US, as well as the implementation and training needs of HIV test counselors to help increase uptake of CHTC to a larger number and wider range of couples in the US. Presently, heterosexual sexual transmission accounts for 25% of new HIV infections in the US. Proposed findings from this mixed method project will help identify strategies to encourage mixed-sex couples to use CHTC, and note the implementation and training needs of HIV test counselors to provide CHTC to a wider group of couples in the US.
