Improving PMTCT Uptake in Rural South Africa

Abstract

Introduction Despite the widespread availability of prevention of mother-to-child transmission (PMTCT) programs, many women in sub-Saharan Africa do not participate in PMTCT. This pilot study aimed to utilize partner participation in an intervention to support PMTCT uptake. Methods Couples (n = 239) were randomized to receive either a comprehensive couples-based PMTCT intervention or the standard of care. Results Compared to the standard of care, participants receiving the intervention increased HIV- and PMTCT-related knowledge (F1,474 = 13.94, p = .004) and uptake of PMTCT, as defined by infant medication dosing (74% vs. 46%, χ2 = 4.69, p = .03). Discussion Results indicate that increasing male attendance at antenatal clinic visits may be “necessary but not sufficient” to increase PMTCT uptake. Increasing HIV knowledge of both partners and encouraging active male participation in the PMTCT process through psychoeducational interventions may be a strategy to increase the uptake of PMTCT in South Africa.

A systematic review of interventions to improve prevention of mother‐to‐child HIV transmission service delivery and promote retention

“…Most studies measured several outcomes on the PMTCT cascade. Most studies were conducted in sub-Saharan Africa: 13 in South Africa [5–17]; eight in Kenya [18–25]; two studies each in Malawi [26,27], Zambia [28,29] and Mozambique [30,31]; and one study each in Democratic Republic of Congo [32], Swaziland [33], Tanzania [34], Rwanda [35] and Ethiopia [36]. Only one study was conducted in United States of America [37].…”

“…Five studies evaluated the association of male partner involvement in PMTCT utilization [17,21,23,27,34]. Four studies sought to determine whether male partner involvement, described as a male partner accompanying his pregnant spouse to antenatal clinic, would impact infant HIV acquisition [23] and PMTCT uptake [21,27,34].…”

“…Four studies sought to determine whether male partner involvement, described as a male partner accompanying his pregnant spouse to antenatal clinic, would impact infant HIV acquisition [23] and PMTCT uptake [21,27,34]. The other study sought to determine whether male participation in the counselling session that utilized a cognitive-behavioural skill approach would significantly impact PMTCT uptake compared to male attendance at antenatal visits only [17]. …”

“…Positive results were reported in the only study that used mobile phone text messages [22]. The four studies [17,23,27,34] that evaluated male participation to improve ARV/ART uptake reported non-significant results (pooled RR 1.12; 95% CI 0.98 to 1.28) (Figure 2). …”

“…The four studies [5,12,15,17] that were grounded on psychological interventions to improve ARV/ART uptake reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09) (Figure 3). …”