Couple-based intervention to improve HIV care engagement for women and their partners in KwaZulu-Natal, South Africa: outcomes of pilot randomized controlled trial

We evaluated a couple-based intervention targeting human immunodeficiency virus (HIV) care needs of women, with the option to support HIV-related needs of male partners. Adult women with HIV adherence difficulties in a monogamous relationship with a male partner for ≥6 months were recruited in KwaZulu-Natal, South Africa. Twenty couples were randomized (1:1) to either START Together, a five-session manualized behavioral intervention, or treatment as usual, adherence counseling referral. Assessments were completed at baseline, post-treatment, and follow-up. Of the ten couples randomized to START Together, 70% attended at least one intervention session (feasibility); of those, 71% attended all five sessions (acceptability). Independently rated interventionist fidelity was very high (M ≥2.94 out of 3). Women’s self-reported antiretroviral therapy adherence increased similarly in both interventions. For men, self-reported antiretroviral therapy adherence increased up to 25 percentage points in START Together, but not treatment as usual. Findings suggest that START Together may be potentially beneficial for improving HIV outcomes for men.