Male involvement for increasing the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) programmes

Brusamento, Serena; Ghanotakis, Elena; Car, Lorainne Tudor; van-Velthoven, Michelle HMMT; Majeed, Azeem; Car, Josip

doi:10.1002/14651858.cd009468.pub2

Cited by 53 publications

(38 citation statements)

References 22 publications

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“…24 The high levels of male partner testing and couples testing achieved in this study are noteworthy since accessing male partners at clinics has proven challenging and provider-initiated strategies such as the provision of written invitations for partners or conducting home visits have either had limited success or are likely to require significant financial and human resources for implementation. 25–27 These results suggest that provision of multiple self-tests to women attending antenatal and postpartum clinics should receive further consideration.…”

Section: Discussionmentioning

confidence: 98%

Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study

et al. 2016

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Summary Background Identifying interventions to increase men’s uptake of HIV testing in sub-Saharan Africa is essential for the success of combination HIV prevention. HIV self-testing is an emerging approach with high acceptability, but limited evidence exists on optimal strategies for distributing self-tests. We explored a novel approach of providing multiple self-tests to women at high risk of HIV acquisition in order to promote partner HIV testing and facilitate safer sexual decision-making. Methods HIV-uninfected women aged 18–39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal (ANC) and postpartum (PPC) clinics, and a drop-in center for female sex workers (FSW). Following informed consent and instructions on using the OraQuick Rapid HIV 1/2 Test, index participants (IPs) enrolled at the health facility and drop-in center received 3 and 5 self-tests, respectively. Structured interviews were conducted with IPs at enrollment and over 3 months to determine how self-tests were used. Key outcomes included the number of self-tests distributed by IPs, the proportion of IPs whose sexual partners used a self-test, couples testing, and sexual behavior following self-testing. Findings Between January 14, 2015 and March 13, 2015, 280 IPs were enrolled (61 ANC, 117 PPC, 102 FSW). Follow-up interviews were completed with 265 IPs (96%). Most IPs with a primary sexual partner distributed a self-test to that partner (53/58, 91% ANC; 91/106, 86% PPC; 64/85, 75% FSW). A vast majority of FSW IPs also distributed ≥1 self-tests to commercial sex clients (82/101, 81%). Among self-tests distributed to and used by IPs’ primary sexual partners, couples testing occurred frequently (27/53, 51% ANC; 62/91, 68% PPC; and 53/64; 83% FSW). Among self-tests distributed to and used by IPs’ sexual partners, an HIV-positive result was obtained for 3.8% (2/53), 2.2% (2/91), and 13.8% (41/298) of the tests in the ANC, PPC, and FSW participant groups, respectively. Sexual intercourse was significantly less likely after a sexual partner tested HIV-positive versus HIV-negative (18% vs. 62%, p<0.0001), while condom use was significantly more likely (100% vs. 44%, p=0.0018). Of 265 IPs with follow-up data, four reported intimate partner violence as a result of self-test distribution. No other adverse events were reported. Interpretation Provision of multiple HIV self-tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop self-testing policies and programs.

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Section: Discussionmentioning

confidence: 98%

Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study

et al. 2016

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“…Consequently, evidence for the strategies’ effectiveness is sparse. A Cochrane systematic review (18) found only one study from Tanzania, an invitation card intervention, for inclusion in the review and concluded that further rigorous research is needed to inform evidence-based recommendations.…”

Section: Discussionmentioning

confidence: 99%

Strategies to improve male involvement in PMTCT Option B+ in four African countries: a qualitative rapid appraisal

Besada

Rohde

Goga

et al. 2016

Global Health Action

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BackgroundThe World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This ‘test and treat’ approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT). This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Côte d'Ivoire in the context of scale-up of Option B+ protocol.DesignData were collected through qualitative rapid appraisal using focus groups and individual interviews during field visits to the four countries. Interviews were conducted in the capital city with Ministry of Health staff and implementing partners (IPs) and at district level with district management teams, facility-based health workers and community health cadres in each country.ResultsCommon strategies were adopted across the countries to effect social change and engender greater participation of men in maternal, child and women's health, and PMTCT services. Community-based strategies included engagement of community leaders through dialogue and social mobilization, involving community health workers and the creation and strengthening of male peer cadres. Facility-based strategies included provision of incentives such as shorter waiting time, facilitating access for men by altering clinic hours, and creation of family support groups.ConclusionsThe approaches implemented at both community and facility levels were tailored to the local context, taking into account cultural norms and geographic regional variations. Although intentions behind such strategies aim to have positive impacts on families, unintended negative consequences do occur, and these need to be addressed and strategies adapted.A consistent definition of ‘male involvement’ in PMTCT services and a framework of indicators would be helpful to capture the impact of strategies on cultural and behavioral shifts. National policies around male involvement would be beneficial to streamline approaches across IPs and ensure wide-scale implementation, to achieve significant improvements in family health outcomes.

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“…In communities where women are restricted from making independent HIV-related health decisions, the WHO, implementing partner organizations, and national health services have encouraged the inclusion of male partners in ANC services to increase uptake of PMTCT services, supplementing couples counseling whenever possible (6, 24–28). Some, but not all, programs have resulted in improved PMTCT uptake (29, 30). Different models of male engagement have been implemented throughout sub-Saharan Africa (SSA) to increase partner accompaniment, including encouraging women to invite their own partners (4, 17), the use of clinic invitation letters (5, 31), and having community health educators/advocates visit couples’ homes to initiate testing recruitment and/or counseling (31, 32).…”

Section: Introductionmentioning

confidence: 99%

“…Different models of male engagement have been implemented throughout sub-Saharan Africa (SSA) to increase partner accompaniment, including encouraging women to invite their own partners (4, 17), the use of clinic invitation letters (5, 31), and having community health educators/advocates visit couples’ homes to initiate testing recruitment and/or counseling (31, 32). A systematic Cochrane review that reviewed a single eligible study from Tanzania cautioned that this strategy could lead to a paradoxical decreased uptake of ANC services, including HIV testing and PMTCT, if women feared participating in partners-based testing (30, 33). Engaging men may also lead to gender-based violence, if couples are serodiscordant (34, 35).…”

Section: Introductionmentioning

confidence: 99%

Engagement of Men in Antenatal Care Services: Increased HIV Testing and Treatment Uptake in a Community Participatory Action Program in Mozambique

et al. 2016

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Uptake of HIV testing and antiretroviral therapy (ART) services during antenatal care (ANC) in rural Mozambique is disappointing. To nurture supportive male engagement in ANC services, we partnered with Traditional Birth Attendants and trained a new type of male-to-male community health agent, “Male Champions”, who focused on counseling male partners to create new, male-friendly community norms around engagement in spousal/partner pregnancies. We assessed ANC service uptake using a pre-post intervention design. The intervention was associated with increases in: (1) uptake of provider-initiated counseling and testing among pregnant woman (81% vs. 92%; p<0.001); (2) male engagement in ANC (5% vs. 34%; p<0.001); and (3) uptake of ART (8% vs. 19%; p<0.001). When men accepted HIV testing, rates of testing rose markedly among pregnant women. With the challenges in scale-up of Option B+ in sub-Saharan Africa, similar interventions may increase testing and treatment acceptability during pregnancy.

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Male involvement for increasing the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) programmes

Abstract: Male involvement for increasing the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) programmes.

Cited by 53 publications

References 22 publications

Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study

Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study

Strategies to improve male involvement in PMTCT Option B+ in four African countries: a qualitative rapid appraisal

Engagement of Men in Antenatal Care Services: Increased HIV Testing and Treatment Uptake in a Community Participatory Action Program in Mozambique

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