Male partner involvement improves HIV testing during pregnancy

Studies presented at the Nineteenth International AIDS Conference (AIDS 2012) in Washington DC called attention to the benefits of increasing male involvement in prevention of mother-to-child transmission (PMTCT) efforts. Most notably, a Tanzanian study involving 354 facilities documented a major increase in the number of male partners undergoing HIV testing during the intervention period.

A major challenge in the PMTCT field is the difficulty of retaining at-risk pregnant women throughout the series of interventions that need to occur for good programmatic outcomes. These include timely presentation for antenatal care; HIV testing; the delivery of test results; the initiation of antiretroviral regimens for HIV-positive women; safe delivery; infant HIV testing; and the initiation of treatment in infants found to be HIV-positive.

It is theorised that in many settings, the male partners of pregnant women may exert considerable influence on women’s health-seeking behavior. A lack of partner support may hinder women’s uptake of PMTCT services, and therefore promoting male partner involvement has been proposed as a strategy for improving health outcomes – not only for infants, but for their mothers and fathers as well.

The Tanzanian study analysed data collected from 354 facilities before and after the introduction of interventions to promote male involvement.Researchers found that the number of male partners tested annually for HIV increased from 1746 at baseline to 22,623 three years later. Only 7% of male partners underwent testing in the absence of partner interventions, whereas 50% did so after the interventions had been in place for three years.

Interventions included letters inviting partners to attend antenatal appointments; posters encouraging male attendance; the prioritisation of clients who attended with partners; improvements to clinic rooms for couples counselling; training for providers on PMTCT couples counseling; and the engagement of villages in developing local strategies.

The study found a higher level of male participation at facilities where there was strong community support.

A poster presentation reported on the results of another Tanzanian intervention that sought to increase male involvement in PMTCT. Antenatal care providers, community leaders and community volunteers conducted activities in 25 villages, including public meetings in eight villages. Before the intervention, only 22% of HIV-positive mothers chose to access HIV care and treatment services; after the intervention, this proportion increased to 57%.

There was also evidence of impact in relation to infant outcomes. The proportion of HIV-exposed infants receiving antiretroviral prophylaxis increased from 35% to 41%. The proportion of infants tested for HIV increased from 28% to 39%.

Another poster presentation reported on an intervention to increase male involvement in PMTCT at a rural hospital in northern Nigeria. After a community sensitisation campaign was carried out, HIV testing among pregnant women increased from 40% to 96%.