The purpose of this study is to collect quantitative data related to developing and testing a couple-based intervention (CBI) for HIV-positive women's medication adherence in the region of Kwazulu-Natal, South Africa. The CBI, called START (Supporting Treatment for Anti-Retroviral Therapy) Together, will be a manualized intervention focused on women's ART adherence and enhancing the couple's communication and problem-solving behavior. The study focuses on implementation outcomes (feasibility, acceptability, and fidelity) and preliminary efficacy outcomes (women's ART adherence, men's engagement in HIV care, and the couple's relationship functioning), which will be compared to a control condition of referrals to usual HIV care.
Inclusion Criteria: * Both partners aged 18 or over * HIV-positive woman diagnosed ≥ 3 months prior to study entry * HIV-positive woman demonstrates difficulty with HIV treatment engagement, defined as either self-reported ART adherence difficulties, evidence of missed clinic visits over the past year (collected from medical records), or evidence of being not virally suppressed (≥ 50 copies/mL) in the past year * In a committed, heterosexual, monogamous romantic relationship for at least 6 months * Both partners willing to participate in treatment to support women's ART adherence * Both partners reside in Vulindlela, or neighboring community, KwaZulu-Natal, South Africa * Willing to have intervention sessions audio-recorded (if randomized to the intervention group) * Able to comfortably communicate in either isiZulu or English Exclusion Criteria: * Report of moderate or severe relationship violence past year * Either partner previously participated in a couple-based HIV prevention or treatment program