A couples-based risk
reduction intervention reduced hepatitis C virus (HCV) incidence and levels of
sexual risk-taking among drug-involved couples, investigators report in the
online edition of the Journal of Acquired
Immune Deficiency Syndromes. The study was conducted in Kazakhstan, which
has one of the fastest growing HIV epidemics in the world and a high prevalence
of injecting drug use.
team of investigators recruited 300 drug-involved heterosexual couples who were
randomised to participate in a focused sexual health and injecting drug use risk
reduction programme or a general wellness programme. HCV incidence was lower
among participants in the risk reduction arm, who were also less likely to
report unprotected sex. Risky injecting practices were reduced in both study arms.
The authors note
this is the first randomised controlled trial “in which a couple-based
HIV/HCV/STI [sexually transmitted infection] intervention demonstrated effect
for both biological and behavioral endpoints.”
High rates of
unprotected sex and unsafe injecting practices have led to epidemics of HIV and
HCV among people who inject drugs in Kazakhstan.
Research has found
that couple-based behavioural interventions can reduce sexual and drug-related
risk behaviours. An international research team therefore designed a randomised
controlled trial to see if such an intervention could reduce rates of new
HIV, HCV, and STIs and reduce risky sexual and drug use behaviours among
drug-involved couples in Almaty, Kazakhstan.
Between 2009 and
2012, a total of 300 heterosexual couples were recruited via word of mouth. They
were randomised to participate in the focused risk reduction sessions or the
general wellness programme.
The risk reduction
intervention was based on an HIV prevention intervention designed and tested
using couples in New York City. Its core
components focused on strategies to reduce HIV, HCV and STI risk;
communication, negotiation and problem-solving skills that couples could use
together to reduce sexual and drug-related risk; the development of skills in
condom use and learning about pleasurable safer sex practices; the cleaning of injecting equipment and strategies for obtaining new injecting equipment.
programme had components on diet, fitness, access to health and drug treatment
services, stress reduction techniques and the setting of personal goals.
included sessions on overdose prevention and response.
At least one
partner in each couple reported injecting drug use in the previous three
months. The median age of participants was 35 years and 87% were married.
Almost half reported having insufficient money for food in the previous three
months. At baseline, 26% of participants were identified as HIV positive, 77%
were positive for HCV and 6% had a STI.
Incidence of new
HCV infections was 7.4 per 100 person-years among individuals in the risk
reduction arm compared to 20 per 100 person-years in the control arm. Participants
in the intervention arm therefore had a significant 69% lower incidence of HCV
infection compared to people in the wellness programme.
Incidence of HIV
and STIs was also lower in the risk reduction arm compared to the control arm
(51% and 37%, respectively), but the differences between the two groups were
the risk reduction programme had a positive impact on sexual risk behaviour. Participants in the risk reduction arm had a 42% lower incidence of unprotected
vaginal sex acts compared to individuals in the wellness programme and were
more than twice as likely to report consistent condom use (OR = 2.30 95% CI
reductions in sexual risk were mainly seen in the first three months of
follow-up. “These findings demonstrate the strength of the risk reduction
intervention in reducing risky sexual behaviors early on, and suggest that
additional effort such as booster sessions may be helpful in maintaining
changes in behavior change over time,” comment the authors.
Participants in both
the risk reduction and wellness programmes reported substantial reductions in
rates of needle sharing and unsafe injecting over the follow-up period, and
there were no significant differences between the study arms.
“We speculate that
this reduction in drug risks can be attributed to the overdose prevention and
health-related content that was included in both arms of the study,” write the
They call for
further research to see how changes in sexual behaviour associated with a risk
reduction programme can be maintained in the longer term.