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Table 1 Description of intervention components

From: Uthando Lwethu (‘our love’): a protocol for a couples-based intervention to increase testing for HIV: a randomized controlled trial in rural KwaZulu-Natal, South Africa

Intervention component

Attendees

Component description

Themes in the session

Content of session/key points covered

Group session 1

All couples prior to randomization

1. Half-day workshop

Tuberculosis (TB), including information on:

TB symptoms and spread

  

2. Co-led by a male and female facilitator

  
    

What to do if exposed to TB

  

3. Information/education

  
  

4. Randomization at the end

 

How one can get tested for TB

    

TB treatment

   

Alcohol

Overview of alcohol consumption

    

Discussion of the prevalence of alcohol use in the community

    

How alcohol use affects community members

    

Information regarding the size of a ‘standard’ drink

    

Risks of increased alcohol consumption

    

Benefits of drinking less alcohol

   

Sexually transmitted infections (STIs)

Factors that can increase exposure to STIs

    

Treatment and prevention of STIs

    

General information (for example, that some STIs have no symptoms in women)

   

HIV/AIDS

How HIV is transmitted

    

Behaviors that put one at risk for HIV

    

Information about HIV testing (including the window period)

    

Basic information about CHCT

   

Reproductive health

Female menstrual cycle

    

Family planning

Group session 2

Intervention for couples only, split by gender

1. Half-day workshop

General discussion on relationship dynamics

Group discusses relationship dynamics (for example, commitment, trust, intimacy, satisfaction)

  

2. Co-led by a male and female facilitator

  
  

3. Information/education

  
  

4. Randomization at the end

 

How they define these concepts

   

Sexual risk reduction

Potential risk for HIV for partners in long-term relationships

    

Female and male condom demonstration and practice

    

Guidelines on safer sex negotiation, HIV/STIs, and gender

    

CHCT overview

    

HIV treatment (including PMTCT and treatment as prevention)

   

Skills practice

Condom demonstrations (male and female)

   

Community attitudes about gender and relationships

Group discussions of pictures depicting possible scenarios in their community and how they would respond (for example, a woman getting harassed by men, a couple purchasing condoms)

    

Gender-based power (raise awareness of the potential for and consequences of gender-based power differentials in relationships)

    

Concurrent partnerships (including possible gender differences in attitude about concurrent partnerships, and community attitudes about them)

   

Speaker-Listener technique

Speaker-Listener technique is a component of the PREP couples’ relationship education program; it is aimed to improve communication between partners and improve listening skills and empathy for one’s partner [60].

   

Theories covered in group session 2: interdependence theory (role of relationship dynamics), the theory of gender, and power (discussion of gender roles and experiences)

 
   

PREP adaptation: aspects included from the PREP relationship education approach include communication skills and identifying relationship goals

 

Couples’ counseling sessions

Intervention for couples only

1. Four couples’ counseling sessions

Session 1: introduction and goal setting

Overview of couples’ counseling sessions; explanation of couples’ skills training; discussion of relationship expectations; identification of goals for counseling; communication skills

  

2. 90 to 120 minutes each

  
  

3. Based on PREP

  
   

Session 2: communication skills and identification of goals pertaining to CHCT

Identification of barriers/facilitators to meeting that goal, revisit communication skills; guided identification of communication enhancement goals; practice of communication skills; problem-solving skills; identifying goals; identification of community support

    

This session also includes two exercises that encourage couples to think about actions that their partner does that they may not always take notice of or appreciate

    

‘Forgetting something good’ (all original items translated from Zulu from the PREP program, other context-relevant items were added to the list based on staff feedback). The list was adapted to make it culturally appropriate for the rural South African context, and include such things as parenting activities or spending time with their partner

    

‘Words of the heart’ asks each partner to quickly circle positive words that come to mind when they think of their partner (for example, ‘supportive’, ‘respect’, ‘fun’) (all words were translated into Zulu from the PREP program materials). They share the list with each other, which encourages feelings of intimacy and can serve as a reminder of the positive aspects of their relationship and their partner.

   

Session 3: review goals pertaining to CHCT

Identifying positive aspects of partner and relationship; review priority issues around HIV; review communication and problem-solving skills; review goals and plans for change

   

Session 4: managing change and future goals

Review of sessions, goal setting and changes, identifying future goals, discussion of maintenance of change; discussion of possible future events that could impact relationships (for example, children, HIV testing, changes in HIV status, health status changes), identifying future actions to demonstrate love/commitment to partner; closure

  1. CHCT, couples-based HIV counseling and testing; PMTCT, prevention of mother-to-child transmission; PREP, Prevention and Relationship Enhancement Program; STI, sexually transmitted infection; TB, tuberculosis.