Couples-Based Counseling Shows Promise in Preventing HIV Transmission Among Pregnant Women and Their Partners
A recent study presented at the Conference on Retroviruses and Opportunistic Infections (CROI) has revealed promising outcomes for a couples-focused intervention aimed at improving HIV testing, diagnoses, and viral suppression among pregnant couples in western Kenya. Led by Lynae Darbes, PhD— faculty at the University of Michigan’s School of Nursing and a member of the Center for Global Health Equity— the Jamii Bora Study tested the impact of home-based counseling visits on couples' health and relationship dynamics during pregnancy and postpartum. Darbes co-led the study with Dr. Janet Turan of the University of Alabama, Birmingham, along with colleagues from University of North Carolina, Chapel Hill, and the Kenyan Medical Research Institute.
CROI, established in 1993, is a premier venue for researchers to share and discuss groundbreaking research on human retroviruses and associated diseases, including HIV, hepatitis viruses, SARS-CoV-2, and mpox. Each year, the conference highlights pivotal studies that contribute to understanding and combating these global health challenges.
Evaluating the Impact of Home-Based Counseling
The Jamii Bora Study, a randomized controlled trial conducted with 800 pregnant couples in Kenya, aimed to determine whether home-based, couples-focused counseling could outperform other strategies — such as providing HIV self-test kits or standard care — in encouraging couples HIV testing and counseling (CHTC). Specifically, the researchers evaluated whether the intervention could increase uptake of CHTC, improve antenatal care outcomes, reduce maternal HIV viral suppression, improve child survival for those living with HIV, and assess the cost-effectiveness of these approaches.
Counselors visited couples five times throughout the pregnancy and postpartum period to discuss HIV testing, relationship skills, and maternal and child health. The study's findings demonstrated that couples who received home visits or self-test kits were three to four times more likely to participate in CHTC compared to those receiving standard care. Notably, women living with HIV in the home visit group achieved higher rates of viral suppression at 18 months postpartum.
"The primary aim of the study was to increase uptake of couples-based counseling and testing for HIV," said Darbes during a press conference at CROI. "Testing together for HIV and strengthening couple relationship skills is important to achieve optimal family health during pregnancy, postpartum, and beyond."
The intervention also led to higher rates of male HIV diagnoses and identified more serodiscordant couples — couples in which one partner is HIV-positive and the other is not. Additionally, participants in the home visit group reported improved relationship quality, including greater satisfaction, trust, and commitment.
Implications for Global Health Equity
The Jamii Bora Study carries significant implications for global health equity. By targeting pregnant women in Kenya, a group at elevated risk of HIV transmission, the intervention addresses the needs of a vulnerable population often marginalized in healthcare systems. The focus on relationship skills alongside HIV testing reflects a comprehensive approach, acknowledging the social dynamics that influence health behaviors. Increased male engagement is particularly noteworthy, as male participation in reproductive health can lead to more equitable decision-making, reduced stigma, and better support for women. Additionally, the study’s exploration of cost-effectiveness provides a blueprint for resource allocation in low-resource settings.
By making HIV testing more accessible through home-based counseling, the intervention empowers individuals and communities, enhancing autonomy in health decisions. Ultimately, the study's findings offer evidence for policymakers and health organizations to invest in family-centered, home-based interventions, contributing to more equitable health outcomes globally.
As the Center for Global Health Equity continues its efforts to address health disparities worldwide, the insights gained from the Jamii Bora Study offer valuable direction for future interventions in similar contexts.
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This project was funded by a grant from the National Institutes of Health (NIH R01 MH 116736). Principal Investigators: Lynae Darbes, University of Michigan, Janet Turan, University of Alabama, Birmingham