Background: Couples-based HIV counseling and testing (CHCT) is a proven strategy to reduce the risk of HIV
transmission between partners, but uptake of CHCT is low. We describe the study design of a randomized
controlled trial (RCT) aimed to increase participation in CHCT and reduce sexual risk behavior for HIV among
heterosexual couples in rural KwaZulu-Natal, South Africa. We hypothesize that the rate of participation in CHCT will
be higher and sexual risk behavior will be lower in the intervention group as compared to the control.
Methods/design: Heterosexual couples (N = 350 couples, 700 individuals) are being recruited to participate in a
randomized trial of a couples-based intervention comprising two group sessions (one mixed gender, one single
gender) and four couples’ counseling sessions. Couples must have been in a relationship together for at least
6 months. Quantitative assessments are conducted via mobile phones by gender-matched interviewers at baseline,
3, 6, and 9 months post-randomization. Intervention content is aimed to improve relationship dynamics, and
includes communication skills and setting goals regarding CHCT.
Discussion: The Uthando Lwethu (‘our love’) intervention is the first couples-based intervention to have CHCT as its
outcome. We are also targeting reductions in unprotected sex. CHCT necessitates the testing and mutual disclosure
of both partners, conditions that are essential for improving subsequent outcomes such as disclosure of HIV status,
sexual risk reduction, and improving treatment outcomes. Thus, improving rates of CHCT has the potential to improve
health outcomes for heterosexual couples in a rural area of South Africa that is highly impacted by HIV. The results of
our ongoing clinical trial will provide much needed information regarding whether a relationship-focused approach is
effective in increasing rates of participation in CHCT. Our intervention represents an attempt to move away from
individual-level conceptualizations, to a more integrated approach for HIV prevention