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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.