title: Evaluation of a demand-creation intervention for couples' HIV testing services among married or cohabiting individuals in Rakai, Uganda: a cluster-randomized intervention trial.
abstract: BACKGROUND
  Uptake of couples' HIV counseling and testing (couples' HCT) services remains largely low in most settings. We report the effect of a demand-creation intervention trial on couples' HCT uptake among married or cohabiting individuals who had never received couples' HCT.
  
  
  METHODS
  This was a cluster-randomized intervention trial implemented in three study regions with differing HIV prevalence levels (range: 9-43 %) in Rakai district, southwestern Uganda, between February and September 2014. We randomly assigned six clusters (1:1) to receive the intervention or serve as the comparison arm using computer-generated random numbers. In the intervention clusters, individuals attended small group, couple and male-focused interactive sessions, reinforced with testimonies from 'expert couples', and received invitation coupons to test together with their partners at designated health facilities. In the comparison clusters, participants attended general adult health education sessions but received no invitation coupons. The primary outcome was couples' HCT uptake, measured 12 months post-baseline. Baseline data were collected between November 2013 and February 2014 while follow-up data were collected between March and April 2015. We conducted intention-to-treat analysis using a mixed effects Poisson regression model to assess for differences in couples' HCT uptake between the intervention and comparison clusters. Data analysis was conducted using STATA statistical software, version 14.1.
  
  
  RESULTS
  Of 2135 married or cohabiting individuals interviewed at baseline, 42 % (n = 846) had ever received couples' HCT. Of those who had never received couples' HCT (n = 1,174), 697 were interviewed in the intervention clusters while 477 were interviewed in the comparison clusters. 73.6 % (n = 513) of those interviewed in the intervention and 82.6 % (n = 394) of those interviewed in the comparison cluster were interviewed at follow-up. Of those interviewed, 72.3 % (n = 371) in the intervention and 65.2 % (n = 257) in the comparison clusters received HCT. Couples' HCT uptake was higher in the intervention than in the comparison clusters (20.3 % versus 13.7 %; adjusted prevalence ratio (aPR) = 1.43, 95 % CI: 1.02, 2.01, P = 0.04).
  
  
  CONCLUSIONS
  Our findings show that a small group, couple and male-focused, demand-creation intervention reinforced with testimonies from 'expert couples', improved uptake of couples' HCT in this rural setting.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT02492061 . Date of registration: June 14, 2015.
authors: Department of Community Health and Behavioral Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda. jmatovu@musph.ac.ug.
authors: Joseph K B
authors: JK
authors: Matovu
authors: Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors: Jim
authors: J
authors: Todd
authors: Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
authors: Rhoda K
authors: RK
authors: Wanyenze
authors: Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda.
authors: Robert
authors: R
authors: Kairania
authors: Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
authors: David
authors: D
authors: Serwadda
authors: Regional Center for Quality of Health Care, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
authors: Fred
authors: F
authors: Wabwire-Mangen
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D012424:Rural Population; D012698:Serologic Tests; D012747:Sexual Partners; D018454:Spouses; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: Couples’ HCT; Demand creation; Intervention; Rakai; Uganda; Uptake