Uptake of couples HIV testing and counselling among heterosexual couples in Sub-Saharan Africa: a systematic review and meta-analysis.

There is a need for further research to inform policy and practice on Couples HIV Testing and Counselling (CHTC) in Sub-Saharan Africa (SSA). The aim of this systematic review and meta-analysis was to estimate and characterise the uptake of CHTC in the SSA. A comprehensive search of published studies was carried out in six electronic databases. Of 30,273 citations, 14 studies with a total of 97,030 study participants were identified. The pooled CHTC uptake was 31.48% (95%CI: 23.55-40.00) with significant heterogeneity between studies (I2 = 99.98%, p < 0.001). However, the sensitivity analysis after omitting two studies showed the pooled estimate for CHTC uptake was 24.05% (95%CI: 16.65-32.34, I2 = 99.86%, p < 0.001). Sub-group analyses indicated that both the study and population characteristics were a source of heterogeneity. The pooled CHTC uptake was higher among pregnant women and their partners (OR = 1.66, 95%CI: 1.58-1.84), and when one person in the dyad first tested individually (OR = 3.16, 95%CI: 2.69-3.72) compared to their counterparts. These findings suggest that people may be cautious of testing together as a couple. Further studies are required to explore how couples intend to use HIV-testing services including CHTC and under what circumstances CHTC may be beneficial to individuals in a relationship.