Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial

Background Our aim was to determine the efficacy of HIV-1 voluntary counsel ling and testing (VCT) in reducing unprotected intercourse among individual s and sex-partner couples in Nairobi (Kenya), Dar es Salaam (Tanzania), and Port of Spain (Trinidad). Methods Individual or couple participants were randomly assigned HIV-1 VCT or basic health information. At first follow-up (mean 7.3 months after base line) health-information participants were offered VCT and all VCT particip ants were offered retesting. Sexually transmitted infections were diagnosed and treated at first follow-up. The second follow-up (mean 139 months afte r baseline) involved only behavioural assessment, and all participants were again offered VCT. Findings 3120 individuals and 586 couples were enrolled. The proportion of individuals reporting unprotected intercourse with non-primary partners dec lined significantly more for those receiving VCT than those receiving healt h information (men, 35% reduction with VCT vs 13% reduction with health inf ormation; women, 39% reduction with VCT vs 17% reduction with health inform ation), and these results were maintained at the second follow-up. Individu al HIV-1-infected men were more likely than uninfected men to reduce unprot ected intercourse with primary and non-primary partners, whereas HIV-1-infe cted women were more likely than uninfected women to reduce unprotected int ercourse with primary partners. Couples assigned VCT reduced unprotected in tercourse with their enrolment partners significantly more than couples ass igned health information, but no differences were found in unprotected inte rcourse with non-enrolment partners. Couples in which one or both members w ere diagnosed with HIV-1 were more likely to reduce unprotected intercourse with each other than couples in which both members were uninfected. These changes were replicated by those in the health-information group diagnosed with HIV-1 at first follow-up. Interpretation These data support the efficacy of HIV-1 VCT in promoting be haviour change.