title: Correlates of previous couples' HIV counseling and testing uptake among married individuals in three HIV prevalence strata in Rakai, Uganda.
abstract: BACKGROUND
  Studies show that uptake of couples' HIV counseling and testing (couples' HCT) can be affected by individual, relationship, and socioeconomic factors. However, while couples' HCT uptake can also be affected by background HIV prevalence and awareness of the existence of couples' HCT services, this is yet to be documented. We explored the correlates of previous couples' HCT uptake among married individuals in a rural Ugandan district with differing HIV prevalence levels.
  
  
  METHODS
  This was a cross-sectional study conducted among 2,135 married individuals resident in the three HIV prevalence strata (low HIV prevalence: 9.7-11.2%; middle HIV prevalence: 11.4-16.4%; and high HIV prevalence: 20.5-43%) in Rakai district, southwestern Uganda, between November 2013 and February 2014. Data were collected on sociodemographic and behavioral characteristics, including previous receipt of couples' HCT. HIV testing data were obtained from the Rakai Community Cohort Study. We conducted multivariable logistic regression analysis to identify correlates that are independently associated with previous receipt of couples' HCT. Data analysis was conducted using STATA (statistical software, version 11.2).
  
  
  RESULTS
  Of the 2,135 married individuals enrolled, the majority (n=1,783, 83.5%) had been married for five or more years while (n=1,460, 66%) were in the first-order of marriage. Ever receipt of HCT was almost universal (n=2,020, 95%); of those ever tested, (n=846, 41.9%) reported that they had ever received couples' HCT. There was no significant difference in previous receipt of couples' HCT between low (n=309, 43.9%), middle (n=295, 41.7%), and high (n=242, 39.7%) HIV prevalence settings (p=0.61). Marital order was not significantly associated with previous receipt of couples' HCT. However, marital duration [five or more years vis-à-vis 1-2 years: adjusted odds ratio (aOR): 1.06; 95% confidence interval (95% CI): 1.04-1.08] and awareness about the existence of couples' HCT services within the Rakai community cohort (aOR: 7.58; 95% CI: 5.63-10.20) were significantly associated with previous receipt of couples' HCT.
  
  
  CONCLUSIONS
  Previous couples' HCT uptake did not significantly differ by HIV prevalence setting. Longer marital duration and awareness of the existence of couples' HCT services in the community were significantly correlated with previous receipt of couples' HCT. These findings suggest a need for innovative demand-creation interventions to raise awareness about couples' HCT service availability to improve couples' HCT uptake among married individuals.
authors.affiliation: Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; jmatovu@musph.ac.ug.
authors.forename: Joseph K B
authors.initials: JK
authors.lastname: Matovu
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.affiliation: Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Rhoda K
authors.initials: RK
authors.lastname: Wanyenze
authors.affiliation: Regional Center for Quality of Health Care, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.affiliation: Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
mesh_terms: D000293:Adolescent; D000328:Adult; D001364:Awareness; D003376:Counseling / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006679:HIV Seropositivity; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D015995:Prevalence; D012424:Rural Population; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: HIV counseling; Rakai; Uganda; married individuals; testing