Title: Improving adult health in sub-Saharan Africa through couples-focused interventions for HIV, STIs and diabetes
Funder: Department of Health and Social Care

Abstract: The colliding epidemics of adult communicable and non-communicable diseases in sub-Saharan Africa (SSA) mean increasing numbers of men and women are living with more than one diagnosis and managing multi-morbidities and increasingly complex health needs. In working towards a global health goal that all adults are able to live healthy and productive lives, feasible and effective programmes and policies of treatment and prevention are required for markedly different health conditions. Thus, identifying behavioural change strategies that can be incorporated into a range of interventions targeting different diseases has potential for considerable public health benefits.Central to this proposed research programme are the value of couples-focused behaviour change strategies for health intervention research and practice in sub-Saharan Africa. The aim of this five-year programme is to contribute to the design and evaluation of interventions for couples affected by HIV, other STIs and, diabetes in South Africa.What is the rationale for focusing on couples and health behaviour change? The majority of adults are in a partnership and to varying degrees will live shared lives. Evidence suggests that couple-focused interventions may be more effective than individual interventions in facilitating long-term maintenance of behavioural changes in one or both members of a couple. Despite strong rationales that couple-focused interventions could be effective globally, in SSA couples studies are seldom undertaken and few couple-focused health interventions have been rigorously evaluated.Why concentrate on HIV, STIs and diabetes in couples-focused health research in South Africa? South Africa has experienced one of the most severe generalised HIV epidemics in the world. Achieving high rates of regular HIV testing is a priority as HIV treatment is now recommended to start on diagnosis. The high rates of other STIs also have sexual and reproductive health consequences, including genital symptoms, pregnancy complications, infertility, and enhanced HIV transmission. By 2015, diabetes was the second largest cause of death in South Africa. The proportion of people living with diabetes in SSA is relatively low but is increasing more quickly than in other regions due to rapid changes in adult life-expectancy, population ageing, diets and lifestyles.The proposed research is a partnership between the University of Southampton and two South African institutions: Human Sciences Research Council and University of Cape Town. The research has three strands: 1) adapting an existing intervention to substantially enhance promotion of couples HIV testing and counselling among couples who have never tested together for HIV or mutually disclosed their status; 2) developing a couples-focused intervention for couples where one partner has diabetes; and, 3) establishing a research agenda in couples-focused health research in SSA. The programme also seeks to develop capacity in the design of complex interventions, models and theory of behavioural change, quantitative dyadic analyses and, will support other research sites in SSA to prepare for couples-focused research and evaluation.

Lay abstract: More than two-thirds of all HIV-infected adults worldwide live in sub-Saharan Africa (SSA), a region that also has the highest rates of mortality due to diabetes and undiagnosed cases of diabetes. The colliding epidemics of adult communicable and non-communicable diseases in SSA also mean increasing numbers of men and women are living with more than one diagnosis and managing multi-morbidities and increasingly complex health needs. In working towards a global health goal that all adults are able to live healthy and productive lives, feasible and effective programmes and policies of treatment and prevention are required for markedly different health conditions. Thus, identifying behavioural change strategies that can be incorporated into a range of interventions targeting different diseases has potential for considerable public health benefits.Central to this proposed research programme are the value of couples-focused behaviour change strategies for health intervention research and practice in sub-Saharan Africa. The aim of this five-year programme is to contribute to the design and evaluation of interventions for couples affected by HIV, other STIs and, diabetes in South Africa.What is the rationale for focusing on couples and health behaviour change? The majority of adults are in a partnership and to varying degrees will live shared lives. Typically, partners are more similar with respect to mental and physical health and health behaviours than they are to the general population. Among the reasons suggested for health concordance in couples is the propensity to select partners with similar characteristics and the effects of shared physical and social environments. Partners can promote positive health behaviour change and care for each other during ill-health. On the other hand, being in a partnership may also be associated with poorer health or negative health behaviours depending on factors such as the quality of the couples' relationship and interpersonal violence. Evidence suggests that couple-focused interventions may be more effective than individual interventions in facilitating long-term maintenance of behavioural changes in one or both members of a couple. Despite strong rationales that couple-focused interventions could be effective globally, in SSA couples studies are seldom undertaken and few couple-focused health interventions have been rigorously evaluated.Why concentrate on HIV, STIs and diabetes in couples-focused health research in South Africa? South Africa has experienced one of the most severe generalised HIV epidemics in the world. Achieving high rates of regular HIV testing is a priority as HIV treatment is now recommended to start on diagnosis. The high rates of other STIs also have sexual and reproductive health consequences, including genital symptoms, pregnancy complications, infertility, and enhanced HIV transmission. By 2015, diabetes was the second largest cause of death in South Africa. The proportion of people living with diabetes in SSA is relatively low but is increasing more quickly than in other regions due to rapid changes in adult life-expectancy, population ageing, diets and lifestyles.The proposed research is a partnership between the University of Southampton and two South African institutions: Human Sciences Research Council and University of Cape Town. The research has three strands: 1) adapting an existing intervention to substantially enhance promotion of couples HIV testing and counselling among couples who have never tested together for HIV or mutually disclosed their status; 2) developing a couples-focused intervention for couples where one partner has diabetes; and, 3) establishing a research agenda in couples-focused health research in SSA. The programme also seeks to develop capacity in the design of complex interventions, models and theory of behavioural change, quantitative dyadic analyses and, will support other research sites in SSA to prepare for couples-focused research and evaluation.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.1 INDIVIDUAL CARE NEEDS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;INFECTION;METABOLIC AND ENDOCRINE