title: Pilot study of home-based delivery of HIV testing and counseling and contraceptive services to couples in Malawi.
abstract: BACKGROUND
  HIV counseling and testing for couples is an important component of HIV prevention strategies, particularly in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors.
  
  
  METHODS
  This study involved offering CHCT and CFP services to couples in their homes; 180 couples were sampled from households in a peri-urban area of Blantyre. Baseline data were collected from both partners and follow-up data were collected one week later. A pair of male and female counselors approached each partner separately about HIV testing and counseling and contraceptive services and then, if both consented, CHCT and CFP services (pills, condoms and referrals for other methods) were given. Bivariate and multivariate logistic regression analyses were done to examine the relationship between individual partner characteristics and acceptance of the services. Selected behaviors reported pre- and post-intervention, particularly couple reports on contraceptive use and condom use at last sex, were also tested for differences.
  
  
  RESULTS
  89% of couples accepted at least one of the services (58% CHCT-only, 29% CHCT + CFP, 2% CFP-only). Among women, prior testing experience (p < 0.05), parity (p < 0.01), and emotional closeness to partner (p < 0.01) had significant bivariate associations with acceptance of at least one service. Reported condom use at last sex increased from 6% to 25% among couples receiving any intervention. First-ever HIV testing was delivered to 25 women and 69 men, resulting, respectively, in 4 and 11 newly detected infections.
  
  
  CONCLUSIONS
  Home-based CHCT and CFP were very successful in this pilot study with high proportions of previously untested husbands and wives accepting CHCT and there were virtually no negative outcomes within one week. This study supports the need for further research and testing of home- and couple-based approaches to expand access to HCT and contraceptive services to prevent the undesired consequences of sexually transmitted infection and unintended pregnancy via unprotected sex.
authors.affiliation: Population, Family and Reproductive Health Department, Johns Hopkins School of Public Health, 615 N, Wolfe St,, Baltimore, Md 21205, USA. sbecker@jhsph.edu.
authors.forename: Stan
authors.initials: S
authors.lastname: Becker
authors.forename: Frank O
authors.initials: FO
authors.lastname: Taulo
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Hindin
authors.forename: Effie K
authors.initials: EK
authors.lastname: Chipeta
authors.forename: Dana
authors.initials: D
authors.lastname: Loll
authors.forename: Amy
authors.initials: A
authors.lastname: Tsui
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003270:Contraceptive Agents / Q000627:therapeutic use*; D003376:Counseling; D005191:Family Characteristics; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control*; D006699:Home Care Services; D006801:Humans; D008295:Malawi; D008297:Male; D008403:Mass Screening; D010865:Pilot Projects; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012736:Sex Education; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000517:prevention & control; D018454:Spouses; D047568:Unsafe Sex / Q000517:prevention & control*
chemical_list: D003270:Contraceptive Agents