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However, the uptake remains limited in much of sub\u2010Saharan Africa, despite an expanded range of strategies designed to promote access.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following PRIMSA guidelines, we conducted a systematic review to characterize CHTC uptake strategies. Five databases were searched. Full\u2010text articles were included if they were: conducted in sub\u2010Saharan Africa during the study period (1980\u20132019), targeted heterosexual couples, reported at least one strategy to promote CHTC and provided a quantifiable measure of CHTC uptake. After the initial and full\u2010text screening, key features of the studies were abstracted and synthesized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 6188 unique records found in our search, 365 underwent full\u2010text review with 29 distinct studies included and synthesized. Most studies recruited couples through antenatal care (<jats:italic>n<\/jats:italic> = 11) or community venues (<jats:italic>n<\/jats:italic> = 8) and used provider\u2010based HIV testing (<jats:italic>n<\/jats:italic> = 25). The primary demand creation strategies included home\u2010based CHTC (<jats:italic>n<\/jats:italic> = 7); integration of CHTC into clinical settings (<jats:italic>n<\/jats:italic> = 4); distribution of HIV self\u2010testing kits (<jats:italic>n<\/jats:italic> = 4); verbal or written invitations (<jats:italic>n<\/jats:italic> = 4); community recruiters (<jats:italic>n<\/jats:italic> = 3); partner tracing (<jats:italic>n<\/jats:italic> = 2); relationship counselling (<jats:italic>n<\/jats:italic> = 2); financial incentives (<jats:italic>n<\/jats:italic> = 1); group education with CHTC coupons (<jats:italic>n<\/jats:italic> = 1); and HIV testing at other community venues (<jats:italic>n<\/jats:italic> = 1). CHTC uptake ranged from negligible to nearly universal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>We thematically categorized a diverse range of strategies with varying levels of intensity and resources used across sub\u2010Saharan Africa to promote CHTC. Offering CHTC within couples\u2019 homes was the most common approach, followed by the integration of CHTC into clinical settings. Due to heterogeneity in study characteristics, we were unable to compare the effectiveness across studies, but several trends were observed, including the high prevalence of CHTC promotion strategies in antenatal settings and the promising effects of home\u2010based CHTC, distribution of HIV self\u2010tests and integration of CHTC into routine health services. Since 2019, an updated literature search found that combining partner notification and secondary distribution of HIV self\u2010test kits may be an additionally effective CHTC strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There are many effective, feasible and scalable approaches to promote CHTC that should be considered by national programmes according to local needs, cultural context and available resources.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26075","type":"journal-article","created":{"date-parts":[[2023,3,17]],"date-time":"2023-03-17T06:43:27Z","timestamp":1679035407000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Strategies to increase couples HIV testing and counselling in sub\u2010Saharan Africa: a systematic review"],"prefix":"10.1002","volume":"26","author":[{"given":"Karen M.","family":"Hampanda","sequence":"first","affiliation":[{"name":"Department of 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