Project Summary
Couples HIV testing and counseling (CHTC) for male couples in the US has emerged as a promising
dyadic HIV prevention strategy. Interventions such as CHTC, which address HIV-risk within primary
relationships, are an essential component to a comprehensive national prevention strategy. Up to two-thirds of
HIV infections among MSM occur within the context of primary partnerships. Rates are particularly pronounced
for emerging adult MSM (aged 18-29). Estimates suggest 79% to 84% of HIV infections are transmitted by
primary partners5.
The current CHTC protocol is limited in two ways. First, CHTC does not incorporate a focus on drug use –
a well-established correlate of HIV infection risk among YMSM specifically. Second, CHTC provides limited
guidance for formal communication skills training in instances where partners have substantial communication
deficits. To address these limitations, our group has developed and pilot-tested the We Test intervention, which
includes two adjunct CHTC components. The first is a substance use module (SUM) that elicits the formation
of a substance use agreement and a discussion about how partners can support one another in observing drug
use limits. The second is an assertive communication training video (ACTV). Results from our recent pilot RCT
(DA036419, PI-Starks) suggest these components decrease the odds of drug use and drug-related problems.
We now propose a multi-site trial powered to test the efficacy of We Test’s components and evaluate
putative moderators and mediators. The proposed RCT builds directly upon the pilot data generated by
DA036419. Participants include 240 male couples in which at least one partner is age 18 – 29; HIV negative;
and reports recent (past 30 days) drug use; and recent (past 3 months) sexual HIV/STI transmission risk
behavior. The study utilizes biological markers for drug use (fingernail assay), HIV testing, and gonorrhea,
chlamydia, and syphilis. Viral load testing is conducted with HIV positive participants. To increase
generalizability and the feasibility of recruitment, couples be enrolled equally across 2-sites in New York City
and Detroit. Participants will be randomized in a factorial design to receive CHTC as usual; CHTC + SUM;
CHTC + ACTV; or CHTC+SUM+ACTV. Follow-ups will occur at 3-, 6-, 9-, and 12-months post intervention.
Drs. Starks, Stephenson (Co-I), Kahle (Co-I; biostatistician) and Sullivan (Consultant) have substantial
experience in the study of male couples. This group completed the pilot RCT which produced the formative
data for this proposal. The study is supported by the Emory CFAR Prevention Sciences Core and the Clinical
Virology Research Laboratory. The intervention tested is an innovative and highly scalable adaptation of the
existing CHTC intervention. In addition, the integration of a substance use intervention into CHTC might
facilitate uptake by affording access to additional funding sources and expanding the pool of providers who see
the service as relevant. Results would inform the development of a future implementation/effectiveness trial.
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