Can Couple-Based Interventions Prevent the Spread of HIV?

A couple-based Protect and Connect (PACT) intervention was found to reduce instances of risky sexual behavior among individuals in community supervision programs (CSP), which have high rates of HIV and sexually transmitted infections (STI), according to a study in JAMA.

Prevalence rates of HIV and STIs in the United States are higher among individuals in CSPs, which include probation, parole, community court, or alternative-to-incarceration program, than in the general population. Incarceration often results in the termination of sexual partnerships, which can increase chances that individuals will engage in risky sexual and drug-use behaviors.

Researchers sought to determine the effectiveness of a 5-session couple-based prevention intervention, compared with a 1-session counseling, testing, and referral (CTR) program, in reducing acts of condomless sexual intercourse and drug use.

Researchers conducted a 2-arm randomized clinical trial from July 11, 2013, to May 17, 2016. Participants were drug-involved men mandated to CSPs recruited from sites in New York City, New York, and their main female sexual partners. The study included a total of 230 couples split evenly and randomized into either a PACT intervention group or an HIV CTR control group. The mean age of participants was 35 years and 74.1% of participants self-identified as African American.

Biological investigative procedures, including testing for HIV infection and STIs, were performed at baseline and at the 12-month follow up. Behavioral data was collected at 3-, 6-, and 12-month follow-ups.

Compared with the CTR group, PACT group participants reported:

• 33% fewer acts of condomless sexual intercourse with their study partners in the past 90 days
• 70% fewer acts of sexual intercourse with other partners
• 40% fewer sexual acts with all partners compared with control participants
• 26% fewer sexual partners in the past 90 days
• They were less likely to be under the influence of drugs or alcohol the last time they had sexual intercourse with their study partners

Individuals in the PACT group also reported significantly fewer acts of condomless sexual intercourse along each follow-up assessment.

Researchers conducted statistical analysis from November 1, 2017, through June 1, 2018, and were masked to treatment assignment until the final 12-month follow-up assessment was completed on July 7, 2017. Data were locked and study arms were revealed on September 30, 2017. No statistically significant difference between the 2 arms was found regarding injection drug use, additional HIV testing, and entry into drug or alcohol treatment.

The authors believe the study’s findings demonstrate the importance of shifting the focus of HIV prevention from individual oriented strategies to couple-based strategies. They believe that more couple-based HIV interventions should be directed toward individuals in CSPs and new strategies should be developed to promote the delivery of them.

"These findings underscore that the PACT intervention can be scaled up to curb the burgeoning HIV epidemic in CSPs and similar criminal justice settings," they concluded.

Reference

El-Bassel N, Gilbert L, Goddard-Eckrich D, et al. Effectiveness of a couple-based HIV and sexually transmitted infection prevention intervention for men in community supervision programs and their female sexual partners a randomized clinical trial. JAMA Netw Open. 2019;2(3). doi: 10.1001/jamanetworkopen.2019.1139.