Maternal and infant antiretroviral therapy adherence among women living with HIV in rural South Africa: a cluster randomised trial of the role of male partner participation on adherence and PMTCT uptake

Abstract

Mother-to-child transmission of HIV' can occur during the period of pregnancy, childbirth, or breastfeeding. 'Prevention of mother-to-child transmission of HIV' (PMTCT) in Mpumalanga Province, South Africa, is especially vital as the prevalence of HIV is 28.2% in women aged 15-49. PMTCT interventions resulted in a drop of MTCT rates in Mpumalanga from ∼2% in 2015 to 1.3% in 2016. This randomised controlled trial in Mpumalanga examined the potential impact of a lay healthcare worker administered intervention, 'Protect Your Family', on maternal and infant adherence, and to assess the relative influence of male partner involvement on infant and maternal adherence. This cluster randomised controlled trial used a two-phase and two-condition (experimental or control) study design where participants (n = 1399) did assessments both during pregnancy and post-postpartum. Only women participated in Phase 1, and both female and male partners participated in Phase 2. Results indicated that male involvement was associated with self-reported maternal or infant antiretroviral therapy (ART) adherence, but the intervention was not associated with ART adherence. Self-reported adherence was associated with depression, age, and partner HIV status. The study results provide support for the involvement of men in the antenatal clinic setting during pregnancy. Results also support further research on the meaning and assessment of male involvement and clarification of the constructs underlying the concept in the sub-Saharan African context. Outcomes provide support for male involvement and treatment of depression as adjuncts to improve uptake of both maternal and infant medication as part of the PMTCT protocol.

Perinatal Depressive Symptoms and Viral Non-suppression Among a Prospective Cohort of Pregnant Women Living with HIV in Nigeria, Kenya, Uganda, and Tanzania

“…The African Cohort Study (AFRICOS) is an ongoing prospective longitudinal cohort study enrolling people living with HIV (PLWH) at 12 HIV care clinical sites in Kenya, Tanzania, Uganda and Nigeria [ 34 , 39 – 41 ]. These sites are maintained by five President's Emergency Plan for AIDS Relief (PEPFAR) programs.…”

Experiences of Mothers Living With HIV in a South African Prevention of Mother-to-Child Transmission of HIV Programme: A Qualitative Descriptive Study

“…Partner and family support emerged as important components of mothers' support systems, facilitating adherence and linkage to care in the PMTCT programme, which has been reported in other studies in Africa (Jones et al, 2021;Mabunda et al, 2021;Masereka et al, 2019). The support of the male partner (infant's father) was valued; however, for most of the participants, the partner's involvement was unsatisfactory.…”

“…Adherence to the PMTCT programme is influenced by several factors. These include the mother's age (16–24 years) and nondisclosure of HIV status to anyone (Larsen et al, 2019) and lack of male partner involvement (Dirisu et al, 2020; Jones et al, 2021). Dlamini and Mokoboto-Zwane (2019) argue that adherence to treatment and care is directly affected by mothers' knowledge of their condition, and women who have insight regarding their condition are more likely to adhere to ART.…”

Implementation characteristics of father‐inclusive interventions in low‐ and middle‐income countries: A systematic review

“…“There are also systemic barriers to supporting male involvement in rural clinics, such as limited space, which may overshadow the positive benefits of promoting male partner participation.” (Jones et al 80 …”

“…(Turan et al 43 ) "There are also systemic barriers to supporting male involvement in rural clinics, such as limited space, which may overshadow the positive benefits of promoting male partner participation." (Jones et al 80 ) and 4. Multiple studies encountered low participation rates of fathers relative to that of mothers (Table 3).…”