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Optimising a couples-focused intervention to increase couples’ HIV testing and counselling using the person-based approach: a qualitative study in Kwa-Zulu Natal, South Africa

Optimising a couples-focused intervention to increase couples’ HIV testing and counselling using the person-based approach: a qualitative study in Kwa-Zulu Natal, South Africa
Optimising a couples-focused intervention to increase couples’ HIV testing and counselling using the person-based approach: a qualitative study in Kwa-Zulu Natal, South Africa
Objectives: this qualitative study explored how to optimise a couples-focused intervention to promote couples HIV testing and counselling (CHTC).
Setting: Community setting in Kwa-Zulu Natal, South Africa.
Participants: Qualitative interviews were conducted with 20 couples who had participated in a couples-focused intervention and five staff members delivering the intervention. Partners were interviewed individually by researchers of the same gender.
Intervention: a couples-focused intervention comprised of two group sessions and four couples counselling sessions was previously shown to significantly increase uptake to CHTC in Kwa-Zulu Natal, South Africa. However, more than half of couples participating in the intervention still chose not to test together during follow-up.
Analysis: the transcripts were analysed using the table of changes from the person-based approach. Proposed optimisations were discussed with a community group to ensure the intervention was as persuasive and acceptable as possible.
Results: many couples found it challenging to discuss CHTC with their partner due to an implied lack of trust. Optimisations to the intervention were identified to increase readiness to discuss CHTC, including education about serodiscordance, discussions about CHTC by peer mentors, and open discussion of personal barriers to CHTC during couples’ counselling sessions. Additional training for staff in open questioning techniques could help them feel more comfortable to explore couples’ perceived barriers to CHTC, rather than advising couples to test. A logic model was developed to show anticipated mechanisms through which the optimised intervention would increase uptake to CHTC, including increasing knowledge, increasing positive outcome beliefs, and managing negative emotions.
Conclusions: in-depth qualitative research informed optimisations to a couples-focused intervention for further evaluation in South Africa to encourage uptake to CHTC. Suggestions are made for optimal methods to gain open feedback on intervention experiences where participants may be reluctant to share negative views.
Couples-focused, intervention, Couples HIV Counselling and Testing, person-based approach
2044-6055
Morton, Kate
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Mhlakwaphalwa, Tembeka
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Msimango, Lindani
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Van Heerden, Alastair
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Ngubane, Thulani
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Joseph, Philip
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Ngcobo, Nathi
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Feng, Zhixin
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Hosegood, Victoria
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Van Rooyen, Heidi
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Mcgrath, Nuala
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Morton, Kate
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Mhlakwaphalwa, Tembeka
c46d14ec-e3cb-4de4-9cd3-ba6f2bfc2623
Msimango, Lindani
d606e487-a5f1-4615-8c58-b2a2bcf96de7
Van Heerden, Alastair
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Ngubane, Thulani
4ddeba22-78f2-478d-80a0-ee8a8b383633
Joseph, Philip
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Ngcobo, Nathi
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Feng, Zhixin
33c0073f-a67c-4d8a-9fea-5a502420e589
Hosegood, Victoria
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Van Rooyen, Heidi
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Mcgrath, Nuala
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Morton, Kate, Mhlakwaphalwa, Tembeka, Msimango, Lindani, Van Heerden, Alastair, Ngubane, Thulani, Joseph, Philip, Ngcobo, Nathi, Feng, Zhixin, Hosegood, Victoria, Van Rooyen, Heidi and Mcgrath, Nuala (2021) Optimising a couples-focused intervention to increase couples’ HIV testing and counselling using the person-based approach: a qualitative study in Kwa-Zulu Natal, South Africa. BMJ Open. (doi:10.1136/bmjopen-2020-047408). (In Press)

Record type: Article

Abstract

Objectives: this qualitative study explored how to optimise a couples-focused intervention to promote couples HIV testing and counselling (CHTC).
Setting: Community setting in Kwa-Zulu Natal, South Africa.
Participants: Qualitative interviews were conducted with 20 couples who had participated in a couples-focused intervention and five staff members delivering the intervention. Partners were interviewed individually by researchers of the same gender.
Intervention: a couples-focused intervention comprised of two group sessions and four couples counselling sessions was previously shown to significantly increase uptake to CHTC in Kwa-Zulu Natal, South Africa. However, more than half of couples participating in the intervention still chose not to test together during follow-up.
Analysis: the transcripts were analysed using the table of changes from the person-based approach. Proposed optimisations were discussed with a community group to ensure the intervention was as persuasive and acceptable as possible.
Results: many couples found it challenging to discuss CHTC with their partner due to an implied lack of trust. Optimisations to the intervention were identified to increase readiness to discuss CHTC, including education about serodiscordance, discussions about CHTC by peer mentors, and open discussion of personal barriers to CHTC during couples’ counselling sessions. Additional training for staff in open questioning techniques could help them feel more comfortable to explore couples’ perceived barriers to CHTC, rather than advising couples to test. A logic model was developed to show anticipated mechanisms through which the optimised intervention would increase uptake to CHTC, including increasing knowledge, increasing positive outcome beliefs, and managing negative emotions.
Conclusions: in-depth qualitative research informed optimisations to a couples-focused intervention for further evaluation in South Africa to encourage uptake to CHTC. Suggestions are made for optimal methods to gain open feedback on intervention experiences where participants may be reluctant to share negative views.

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Accepted/In Press date: 28 August 2021
Additional Information: Funding This report is independent research supported by the National Institute for Health Research using Official Development Assistance (ODA) funding (NIHR Global Health Research Professorship, NM, RP-2017-08-ST2-008). KM, TM, LM, NN, ZF and NM were supported by this funding.
Keywords: Couples-focused, intervention, Couples HIV Counselling and Testing, person-based approach

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Local EPrints ID: 454313
URI: http://eprints.soton.ac.uk/id/eprint/454313
ISSN: 2044-6055
PURE UUID: 908b0638-03fd-4222-aa68-f0b269d62a0f
ORCID for Kate Morton: ORCID iD orcid.org/0000-0002-6674-0314
ORCID for Victoria Hosegood: ORCID iD orcid.org/0000-0002-2244-2518
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 07 Feb 2022 17:39
Last modified: 17 Mar 2024 06:55

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Contributors

Author: Kate Morton ORCID iD
Author: Tembeka Mhlakwaphalwa
Author: Lindani Msimango
Author: Alastair Van Heerden
Author: Thulani Ngubane
Author: Philip Joseph
Author: Nathi Ngcobo
Author: Zhixin Feng
Author: Heidi Van Rooyen
Author: Nuala Mcgrath ORCID iD

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