SMART Couples

Sharing Medical Adherence Responsibilities Together, or SMART, Couples is an intervention designed for individual discordant couples with poor medication adherence in the HIV-positive partner. SMART Couples educates couples about the importance of adherence to avoid viral resistance.

About SMART Couples

Sharing Medical Adherence Responsibilities Together, or SMART, Couples is a couple-level intervention that consists of four sessions with the patient and their partner and lasts about 45 minutes to an hour. Sessions address adherence to antiretroviral therapy (ART) and safer sex behaviors within the couple dyad by nurturing active support for the partner with HIV from their HIV-negative partner, and vice-versa. The intervention includes cognitive-behavioral components to identify barriers, reinforce health behaviors, and problem-solving strategies to identify and overcome adherence barriers.

Intervention Core Elements

SMART Couples sessions are best delivered by a licensed social worker or counselor, HIV case manager, health educator, or nurse with experience working with a couple dyad and providing adherence counseling and education. Key components of SMART Couples include education about the importance of:

  • Adherence to avoid viral resistance;
  • Health maintenance;
  • Identification of non-adherence patterns; and
  • Increasing social support for positive health outcomes.

Intervention Goals

  • Improve adherence to antiretroviral therapy
  • Increase social support for adherence to antiretroviral therapy and risk reduction
  • Address couple’s sexual transmission concerns
  • Address couple’s issues with sex and intimacy

Target Population

Heterosexual and homosexual HIV-serodiscordant couples, with poor medication adherence in the HIV-positive partner.

SMART Couples Training

There is no CDC-supported training currently available for SMART Couples. Technical assistance for the implementation of SMART Couples is available.

To request technical assistance:

  • CDC’s directly funded health department and CBO partners may request technical assistance by submitting a request in the CBA Tracking System.
  • Organizations not directly funded by CDC may contact their local health department for assistance in submitting a request.

If you have questions or need additional assistance, please contact DHAPCBB@cdc.gov.

Implementation and Marketing Materials

The materials and resources listed below support the implementation and/or marketing of SMART Couples by health departments, community-based organizations, and health care or other organizations. The resources are evidence-based and designed for cost-effective, scalable implementation.

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  • Remien RH, Stirratt MJ, Dolezal C, Dognin JS, Wagner GJ, Carballo-Dieguez A, El-Bassel N, Jung TM. Couple-focused support to improve HIV medication adherence: A randomized controlled trial. AIDS 2005;19(8):807-814.