Background: Most HIV transmission in generalized epidemics in SSA and Zambia occurs in cohabiting heterosexual couples. Couples’ Voluntary counseling and Testing reduces HIV transmission by 47% in concordant negative couples (CNC). However, half of residual infections post-CVCT occur in CNC due to unprotected extramarital sex. Neglected tropical diseases (NTD) and non-communicable diseases (NCD) continue to pose significant public health threats in terms of morbidity and mortality in SSA and Zambia. This thesis will address these public health issues through the use of HIV and non-HIV-related video-based group sessions with couples. Methods: The thesis’ data is from a cluster-randomized trial. “Strengthening Our Vows” intervention or SOV encouraged communication and negotiation of explicit sexual agreements (SA) to prevent HIV through unprotected extramarital sex. The comparator, “Good Health Package” or GHP, focused on health education, health screenings, provision of commodities, and interactive training to prepare couples to implement strategies to prevent NTD and NCD for their family’s health. Questionnaire data from baseline, two-week post-intervention in SOV/GHP, and six months post-intervention in GHP were analyzed. Outcomes measured were baseline sociodemographic and sexual and reproductive behavioral characteristics between arms; communication and negotiating explicit SA in SOV; knowledge and skills uptake, recommendations; household roles; and adoption and maintenance of strategies in GHP. Results: Approximately 24% of CNC at baseline had at least one HIV risk factor. Most SOV spouses chose monogamy as their primary SA. Negotiations at home were friendly, supportive, and lasted 15-60 minutes. Approximately two-thirds of spouses noted at least one threat to remaining HIV-free. The most commonly cited threats were alcohol use, financial pressures, travel, and discord at home. The GHP arm observed increased short-term and sustained long-term (6-month) knowledge and skills uptake for treating water with chlorine and handwashing techniques. Increases were also noted for reducing salt/sugar intake, taking medication, and getting levels checked. Sharing responsibilities increased for collecting and chlorinating water, sharing food purchasing, and caring for sick persons. Conclusion: This thesis highlights that video-based interventions for couples can facilitate communication and negotiation of explicit sexual agreements for HIV prevention. In addition, video-based sessions for couples can increase knowledge and skills uptake, adoption and maintenance of healthy lifestyles, and sharing household roles for NCD and NTD prevention. Findings highlight a critical knowledge gap on NTD and NCD in Zambian CNC. Findings show opportunities for integrating health topics within couples-based research to address a myriad of health issues.