Home-Based Couples Testing Best When Complemented With Counseling

Lynae Darbes, PhD, professor in the Department of Health Behavior and Clinical Sciences at the University of Michigan, discusses research she presented at the 2025 Conference on Retroviruses and Opportunistic Infections that shows home-based counselling was effective in increasing HIV testing along with self-testing kits given to couples.

This transcript was lightly edited; captions were auto-generated.

Transcript

How did the effectiveness of home-based couples HIV testing and counseling compare with self-testing?

We found that both providing self-testing kits for HIV to both partners and our home-based visits improved rates of engaging in couples testing compared to usual care, but the effect for the home-based visits was stronger and resulted in more couples engaging in that behavior. Obviously, self-testing kits are cheaper from a financial perspective, but I think the disadvantage of that is what I was talking about in terms of the lack of counseling and information that is tailored to whatever the testing results are. So if you just test yourself on your own with your partner, you're not going to get that guidance and tailored strategies depending on what those results are. It's also not clear if that mutual disclosure is also happening. It's probably more likely to happen, but we don't know, are both partners doing it at the same time? Are they mutually disclosing to each other? That's not as evident if you just give them the test and they walk away.

Did the study identify any ongoing challenges or limitations?

Our experience, our biggest challenge actually occurred during COVID. The COVID epidemic happened while we were in the middle of implementing this, so we had to stop for a while and start back up. But I think anybody working in this context is going to recognize that some of the challenges were these uncontrollable things like weather. This area gets heavy rains and floods, and so the roads wash out. Some of it is just this infrastructure issue, so people couldn't get to people's houses because the roads were bad. I think that that working around those things was was one of the biggest challenges.

I would say that we were really pleasantly surprised at the high rates of engagement. We had done some pilot work, but not on this scale and so we were really pleasantly surprised at how well we were able to engage people in their homes and complete up to 5 visits with the couple over the course of their pregnancy and following the birth, and also follow them for what ended up being 18 months after the birth of their infants. I think that did underscore the investment and commitment that people had to to improving their knowledge and getting support around these issues for their families.