家庭訪問によるHIV検査とウイルス抑制効果を実証（Home Counseling Visits Increase HIV Testing for Couples, Viral Suppression for Mothers in Kenya）

2026-07-02

2026-06-30 ミシガン大学

ミシガン大学を中心とする国際研究チームは、ケニアで実施した家庭訪問型カウンセリングが、夫婦のHIV検査受診率とHIV陽性妊婦のウイルス抑制率を向上させることを明らかにした。研究では、妊婦とそのパートナーを対象に、自宅でHIV検査やカウンセリングを提供する介入を実施し、その効果を評価した。その結果、家庭訪問を受けた群では夫婦そろってHIV検査を受ける割合が高まり、HIV陽性の母親では抗レトロウイルス療法（ART）の継続や服薬遵守が改善し、ウイルス量が抑制される割合も有意に向上した。これにより、母子感染の予防だけでなく、家族全体のHIV予防や早期治療の促進にもつながることが示された。研究は、医療機関へのアクセスが限られる地域において、家庭訪問を活用した地域密着型支援がHIV対策の有効な手段となることを示しており、サハラ以南アフリカなど高流行地域での公衆衛生政策への応用が期待される。

＜関連情報＞

ケニアにおける妊娠中および産後のカップルを対象としたHIV検査と家族の健康を促進するための介入の効果：多施設共同、カップルを対象とした無作為化比較試験 Effectiveness of interventions to promote couples-based HIV testing and family health during pregnancy and postpartum in Kenya: a multicentre, couples-based, randomised controlled trial

Prof Janet M Turan, PhD ∙ Zachary A Kwena, PhD ∙ Kevin Owuor, DrPH ∙ Anna Helova, DrPH ∙ Abigail M Hatcher, PhD ∙ Prof Thomas M Braun, PhD ∙ et al.
The Lancet HIV Published: June 29, 2026
DOI:https://doi.org/10.1016/S2352-3018(26)00104-9

Summary

Background

Engaging couples during pregnancy can improve HIV prevention and family health. We examined the effectiveness of two couples-focused interventions on uptake of couples HIV testing and counselling (CHTC) and maternal and child health outcomes.

Methods

In this multicentre, couples-based, randomised controlled trial, HIV status-concordant and HIV status-discordant pregnant couples (aged ≥15 years) from 24 antenatal clinics across Migori and Kisumu counties in Kenya were randomly assigned (1:1:1) to one of three study groups: lay counsellors delivered five couple home visits on health and relationship skills and offered CHTC at home (home visit group); HIV self-test kits were given to women to use with their partners (HIV self-test group); standard care access with routine perinatal health services offered at their health facility, including offers of individual and couples HIV testing (standard care group). Couples were followed up to 18 months postpartum. The primary outcome was both couple members reporting CHTC uptake by 12 months postpartum. For analyses, we used generalised linear and generalised estimating equation models. This trial is registered at ClinicalTrials.gov, NCT03547739, and is complete.

Findings

Between March 20, 2019, and July 26, 2022, we recruited and randomly assigned 800 couples to the home visit group (n=267), HIV self-test group (n=266), or standard care group (n=267). Two-thirds (n=533 [66·7%]) of couples included a woman living with HIV. CHTC uptake was higher in the home visit group and HIV self-test group, with 114 (56·2%; adjusted risk ratio 4·22 [95% CI 2·88–6·18]) and 106 (50·0%; 3·69 [2·50–5·45]) couples reporting CHTC by 12 months, compared with 26 (13·6%) in the standard care group. We reported 54 severe adverse events (adverse pregnancy outcomes, none related to study procedures) and 37 adverse events (two possibly related to study procedures).

Interpretation

Both home visits and HIV self-test kits offer a gateway for positive health outcomes for perinatal women and families. Home visits, which directly engage both members of the couple, can provide additional advantages for HIV-related health.

Funding

National Institute of Mental Health.

Translation

For the Kiswahili translation of the abstract see Supplementary Materials section.