Couples-Based HIV Prevention Program Tests PrEP Adherence and Stigma Reduction in South Africa
A cluster randomized trial tests whether couples counseling plus stigma workshops can boost PrEP/ART uptake among young South African adults.
Summary
The Couples Health CoOp Plus trial enrolled 481 young couples in Cape Town to test whether a combined couples-based intervention and community stigma education could improve HIV prevention and treatment outcomes. Twenty-four communities were randomized to receive either a stigma awareness workshop or no workshop, while couples within those communities received either standard HIV testing services or the full CHC+ intervention. The primary goal was to increase initiation and adherence to PrEP and antiretroviral therapy. Secondary goals included reducing alcohol and drug use, sexual risk behaviors, and relationship violence, while improving communication. The trial used a cluster randomized design with a modified factorial structure, allowing researchers to examine both community-level and couple-level effects simultaneously. Results are not yet published from the abstract alone.
Detailed Summary
HIV prevention in sub-Saharan Africa remains a critical global health challenge, particularly among young adults aged 18 to 30. Structural barriers including stigma, relationship dynamics, substance use, and limited access to prevention tools like PrEP frequently undermine standard public health approaches. Addressing these barriers simultaneously requires multilevel interventions that target both individuals and the communities around them.
The Couples Health CoOp Plus trial was designed to do exactly that. Conducted in Cape Town, South Africa, the study enrolled 481 young heterosexual couples from 24 clinic catchment areas serving ART and PrEP patients. Communities were cluster-randomized to receive either a stigma awareness and education workshop or no workshop. Within those communities, couples were assigned to either the CHC+ couples intervention or standard HIV testing services alone, creating a modified factorial design.
The CHC+ intervention was developed with input from Community Collaborative Boards and Peer Advisory Boards, and was specifically adapted to incorporate ART and PrEP support. The primary outcome measured was initiation and adherence to ART or PrEP by both partners. Secondary outcomes included reductions in alcohol and other drug use, sexual risk behaviors, and intimate partner violence, alongside improvements in relationship communication and norms.
The community-level stigma workshops aimed to shift attitudes toward people who use substances and those seeking HIV services, with follow-up assessments at 4 and 8 months. The trial also used mixed methods to examine how the stigma and couples interventions interacted in shaping treatment engagement.
This study is notable for its dual focus on structural stigma and couple-level dynamics as modifiable drivers of HIV prevention. If effective, the CHC+ model could inform scalable programs in high-burden settings. However, since only the abstract is available, specific efficacy data and effect sizes cannot be evaluated at this time.
Key Findings
- Trial tested whether couples counseling plus stigma workshops improves PrEP and ART initiation and adherence.
- 24 Cape Town communities cluster-randomized; 481 young couples enrolled aged 18–30.
- Community stigma workshops aimed to reduce HIV-related stigma and substance use discrimination at 4 and 8 months.
- CHC+ intervention targeted alcohol use, sexual risk, relationship violence, and communication alongside medication adherence.
- Modified factorial design allowed simultaneous testing of community-level and couple-level intervention effects.
Methodology
Cluster randomized trial with a modified factorial design across 24 Cape Town clinic catchment areas. 481 couples were enrolled and randomized to CHC+ intervention or HIV testing services only, with communities separately randomized to stigma workshop or no workshop. Follow-up assessments were conducted at 4 and 8 months post-intervention.
Study Limitations
This summary is based on the abstract only; full results, effect sizes, and outcome data are not available for evaluation. The trial is completed but published findings have not been cited, limiting assessment of actual efficacy. Generalizability beyond urban South African communities with similar clinic infrastructure is unknown.
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