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A Systematic Review of Behavioral Couples-Based Interventions Targeting Prevention of Mother-to-Child Transmission in Low- and Middle-Income Countries

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Abstract

There is increasing focus in HIV prevention and treatment on couples-based approaches. No systematic review has synthesized prospective behavioral couples-based HIV trials targeting prevention of mother-to-child transmission (PMTCT) outcomes in low- and middle-income countries (LMICs). We systematically reviewed published abstracts and articles reporting prospective comparative evaluations of behavioral couples-based HIV interventions delivered during pregnancy to both members of a self-identified heterosexual couple in LMICs following PRISMA. Citations, abstracts, and full texts were double screened for eligibility. References meeting eligibility criteria underwent double data abstraction, quality appraisal, and qualitative synthesis. We identified 295 unique publications. Of these, 5 randomized trials were deemed eligible and synthesized. Studies were conducted in 3 different African countries using three overarching intervention approaches: home-based; group workshops; and faith-based. Studies included various PMTCT outcome measures. We found evidence that behavioral couples-based approaches around the time of pregnancy can positively affect HIV testing among pregnant women and their male partners, infant HIV prophylaxis use, and HIV-free infant survival. The effects on other PMTCT outcomes were not well supported. There was a low to moderate risk of bias among the included studies. Few couples-based PMTCT interventions have been tested in LMICs. Of the interventions we located, workshops/group education and home-based couple counseling and testing were most commonly used to promote PMTCT. Research is needed on the role of relationship dynamics within such interventions and whether couples-based approaches during pregnancy can extend to health outcomes across the PMTCT continuum of care.

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Funding

Support for this project was provided by the U.S. National Institutes of Health under awards K99 MH116735, R00 MH116735 and K24 AI120796.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 13199 East Montview Blvd., Ste. 310, A09, Aurora, CO, 080045, USA

    Karen Hampanda

  2. Center for Global Health, University of Colorado Anschutz Medical Campus, Aurora, USA

    Karen Hampanda, Krysta Pelowich & Lisa Abuogi

  3. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Benjamin H. Chi

  4. Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, USA

    Lynae A. Darbes

  5. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, USA

    Janet M. Turan

  6. Department of Health Policy, The University of Zambia, Lusaka, Zambia

    Wilbroad Mutale

  7. Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, USA

    Lisa Abuogi

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  1. Karen Hampanda
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  2. Krysta Pelowich
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  7. Lisa Abuogi
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Contributions

KH: conceptualization, methodology, formal analysis, funding, acquisition, investigation, resources, writing—original draft, writing—review and editing KP: data curation, formal analysis, writing—original draft, writing—review and editing, software BC: validation, supervision, writing—review and editing LD: validation, supervision, writing—review and editing JM: validation, supervision, writing—review and editing WM: validation, supervision, writing—review and editing LA: resources, conceptualization; methodology, funding acquisition, supervision, writing—original, writing—review and editing, validation.

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Correspondence to Karen Hampanda.

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Hampanda, K., Pelowich, K., Chi, B.H. et al. A Systematic Review of Behavioral Couples-Based Interventions Targeting Prevention of Mother-to-Child Transmission in Low- and Middle-Income Countries. AIDS Behav 26, 443–456 (2022). https://doi.org/10.1007/s10461-021-03401-x

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