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Fletcher R, Forbes F, Dadi AF, Kassa GM, Regan C, Galle A, Beyene A, Liackman R, Temmerman M. Effect of male partners' involvement and support on reproductive, maternal and child health and well-being in East Africa: A scoping review. Health Sci Rep 2024; 7:e2269. [PMID: 39086507 PMCID: PMC11286546 DOI: 10.1002/hsr2.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 06/23/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
Background and Aims East African countries have high rates of maternal and child mortality and morbidity. Studies have shown that the involvement of male partners in reproductive health can benefit maternal and child health (MCH). This scoping review aims to provide an overview of the evidence across East Africa that describes male partner involvement and its effect on maternal, reproductive, and child well-being. Methods Ten databases were searched to identify quantitative data on male's involvement in East Africa. Studies reporting qualitative data, "intention to use" data or only reporting on male partner's education or economic status were excluded. Studies were organized into five a priori categories: antenatal care (ANC), human immunodeficiency virus, breastfeeding, family planning, and intimate partner violence with further categories developed based on studies included. Results A total of 2787 records were identified; 644 full texts were reviewed, and 96 studies were included in this review. Data were reported on 118,967 mothers/pregnant women and 15,361 male partners. Most of the studies (n = 83) were reported from four countries Ethiopia (n = 49), Kenya (n = 14), Tanzania (n = 12) and Uganda (n = 10). The evidence indicates that male partner involvement and support is associated with improved reproductive, MCH across a wide range of outcomes. However, the studies were heterogeneous, using diverse exposure and outcome measures. Also, male partners' lack of practical and emotional support, and engagement in violent behaviors towards partners, were associated with profound negative impacts on MCH and well-being. Conclusions The body of evidence, although heterogeneous, provides compelling support for male involvement in reproductive health programs designed to support MCH. To advance research in this field, an agreement is needed on a measure of male partner "involvement." To optimize benefits of male partners' involvement, developing core outcome sets and regional coordination are recommended.
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Affiliation(s)
- Richard Fletcher
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Faye Forbes
- College of Health SciencesDebre Markos UniversityDebre MarkosEthiopia
- Global and Women's Health Unit, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Abel Fekadu Dadi
- Menzies School of Health ResearchCharles Darwin University, NT, Australia & Addis Continental Institute of Public HealthAddis AbabaEthiopia
| | | | - Casey Regan
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Anna Galle
- Department Public Health and Primary CareInternational Centre for Reproductive Health, Ghent UniversityGhentBelgium
| | - Addisu Beyene
- School of Public Health, College of Health and Medical SciencesHaramaya UniversityHararEthiopia
- Centre for Women's Health Research, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
| | - Rebecca Liackman
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Marleen Temmerman
- Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Centre of Excellence in Women and Child HealthAga Khan UniversityNairobiKenya
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Audet CM, Graves E, Shepherd BE, Prigmore HL, Brooks HL, Emílio A, Matino A, Paulo P, Diemer MA, Frisby M, Sack DE, Aboobacar A, Barreto E, Van Rompaey S, De Schacht C. Partner-Based HIV Treatment for Seroconcordant Couples Attending Antenatal and Postnatal Care in Rural Mozambique: A Cluster Randomized Controlled Trial. J Acquir Immune Defic Syndr 2024; 96:259-269. [PMID: 38905476 PMCID: PMC11196005 DOI: 10.1097/qai.0000000000003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/25/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION There is evidence that a supportive male partner facilitates maternal HIV testing during pregnancy, increases maternal antiretroviral therapy initiation and adherence, and increases HIV-free infant survival. Most male partner engagement clinical strategies have focused on increasing uptake of couple-based HIV testing and counseling. We delivered a couple-based care and treatment intervention to improve antiretroviral therapy adherence in expectant couples living with HIV. METHODS We implemented a cluster randomized controlled trial for seroconcordant couples living with HIV, comparing retention (using a patient's medication possession ratio) in HIV care for a couple-based care and treatment intervention vs. standard of care services in rural Mozambique. The intervention included couple-based treatment, couple-based education and skills building, and couple-peer educator support. RESULTS We recruited 1080 couples to participate in the study. Using a linear mixed effect model with a random effect for clinic, the intervention had no impact on the medication possession ratio among women at 12 months. However, the intervention increased men's medication ratio by 8.77%. Our unadjusted logistic regression model found the odds of an infant seroconverting in the intervention group was 30% less than in the control group, but the results were not statistically significant. DISCUSSION Our study found no difference in maternal outcomes by study arm, but our intervention resulted in an improved medication possession ratio among male partners. We provide a community/clinic-based treatment framework that can improve outcomes among male partners. Further work needs to be done to improve social support for pregnant women and to facilitate prevention of vertical transmission to infants among couples living with HIV.
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Affiliation(s)
- Carolyn M Audet
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Nashville, TN
| | - Erin Graves
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Nashville, TN
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Heather L Prigmore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Hannah L Brooks
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Nashville, TN
| | | | | | - Paula Paulo
- Friends in Global Health, Quelimane, Mozambique
| | | | - Michael Frisby
- Department of Educational Policy Studies, Georgia State University, Atlanta, GA; and
| | - Daniel E Sack
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Nashville, TN
| | - Arifo Aboobacar
- Provincial Health Directorate of Zambézia, Quelimane, Mozambique
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Brooks HL, Graves E, De Schacht C, Emílio A, Matino A, Aboobacar A, Audet CM. "If It Weren't for This, We'd Be Sick"-Perspectives From Participants of a Couple-Based HIV Treatment and Support Program During Prenatal and Postpartum Periods in Zambézia Province, Mozambique. J Acquir Immune Defic Syndr 2024; 96:304-310. [PMID: 38032747 PMCID: PMC11128476 DOI: 10.1097/qai.0000000000003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Engagement in HIV care and treatment services during pregnancy is key to eliminating vertical transmission. One barrier to retention of pregnant and lactating women is insufficient support from male partners. Reframing HIV services as couple-based may increase adherence among men and women. As part of a cluster randomized trial evaluating an intervention offering seroconcordant couples living with HIV joint follow-up in HIV services and sessions with a health counselor and couple peer educators, we assessed participants' perspectives and experiences regarding the intervention. SETTING Zambézia Province is a rural, low-income, and medically underserved region of central Mozambique. METHODS We conducted semistructured interviews with a subset of participants enrolled in the intervention arm. The objectives were to explore participants' (1) experiences with couples-based HIV care and the educational/support sessions; (2) perceived impacts of the intervention; and (3) suggestions for intervention improvement. Interviews conducted by experienced interviewers were audio-recorded, transcribed, and deductively coded. RESULTS Sixty-four participants were interviewed. Participants described the counselor and the peer educators as trustworthy and the sessions as improving their HIV-related knowledge. Receiving joint HIV services was convenient and motivated some participants to remain adherent to care. Participants provided few suggestions to improve the intervention, although a few female participants did state that they wished their male partners had participated more readily in the joint sessions and medication pick-ups at the health facilities. CONCLUSIONS Participants described positive experiences with and perceived benefits from the intervention, making this intervention acceptable within the local context.
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Affiliation(s)
- Hannah L Brooks
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Arifo Aboobacar
- Provincial Health Directorate of Zambézia, Quelimane, Mozambique; and
| | - Carolyn M Audet
- Departments of Health Policy and Epidemiology, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
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Hampanda K, Scandlyn J, Fasano M, Matenga TFL, Onono M, Odwar TO, Mutale W, Shankalala P, Chi BH, Turan JM, Abuogi LL. Money, chores and emotional support: Kenyan and Zambian fathers' perceptions of male partner involvement in maternal and infant health within the context of HIV. CULTURE, HEALTH & SEXUALITY 2024; 26:747-762. [PMID: 37694847 DOI: 10.1080/13691058.2023.2249078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
In sub-Saharan Africa, involving male partners in the prevention of mother-to-child transmission of HIV improves maternal and infant outcomes. Male involvement is typically conceptualised as male partners attending antenatal care, which is difficult for many men. Little is known about how men view their involvement in family health within the context of HIV, particularly outside of clinic attendance. Through interviews with 35 male partners of pregnant or postpartum women living with HIV in Kenya and Zambia, this study elicited perceptions of male involvement in maternal and infant health in families affected by HIV. Men supported the importance of clinic attendance but reported conflicts with the need to work and fulfil their role as the family's financial provider. Providing money for necessities was deemed more critical for their family's health than clinic attendance. Men's involvement was conveyed through various other supportive actions, including helping with household chores and providing emotional support (showing love and reducing women's stress). Future strategies to promote male partner involvement in the prevention of mother-to-child transmission of HIV and maternal and child health should build upon the actions men view as most meaningful to promote their family's health within their real-world life circumstances and cultural context, particularly their role as financial providers.
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Affiliation(s)
- Karen Hampanda
- Obstetrics and Gynaecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Jean Scandlyn
- Health and Behavioural Sciences and Anthropology, University of Colorado, Denver, CO, USA
| | - Marcella Fasano
- Obstetrics and Gynaecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | | | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Tobias O Odwar
- Impact Research and Development Organization (IRDO), Kisumu, Kenya
| | - Wilbroad Mutale
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Benjamin H Chi
- Obstetrics and Gynaecology, University of North Carolina, Chapel Hill, NC, USA
| | - Janet M Turan
- Health Care Policy and Organization, School of Public Health, University of Alabama, Birmingham, AL, USA
| | - Lisa L Abuogi
- Paediatrics, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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Sao SS, Coleman JN, Minja L, Mwamba RN, Kisigo GA, Osaki H, Renju J, Mmbaga BT, Watt MH. Who is most vulnerable? Factors associated with presenting to antenatal care without a male partner in Northern Tanzania. Midwifery 2024; 132:103962. [PMID: 38489854 PMCID: PMC11129849 DOI: 10.1016/j.midw.2024.103962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Male engagement in pregnancy care can be beneficial for maternal and child health outcomes. In Tanzania, pregnant women are strongly encouraged to present to their first antenatal care (ANC) appointment with a male partner, where they jointly test for HIV. For some, this presents a barrier to ANC attendance. The objectives of this study were to identify factors associated with presenting to ANC with a male partner using a cross-sectional design and to assess whether women presenting without partners had significantly delayed presentation. METHODS Pregnant women (n = 1007) attending a first ANC appointment in Moshi, Tanzania were surveyed. Questions captured sociodemographic characteristics and measures of psychosocial constructs. RESULTS Just over half (54%) of women presented to care with a male partner. Women were more likely to present with a male partner if they were younger than 25 years old, married, Muslim, attending ANC for their first pregnancy, and testing for HIV for the first time. Women presenting to ANC with a male partner were significantly more likely to attend ANC earlier in their pregnancy than those presenting without male partners. CONCLUSION Policy change allowing women to present to care with other supportive family members could promote earlier presentation to first ANC. Unmarried women may be at a disadvantage in presenting to ANC when policies mandate attendance with a male partner. Male partners of multiparous women should be encouraged to provide pregnancy support even after first pregnancies, and a wholistic emphasis (beyond HIV testing) on first ANC could encourage male engagement beyond the initial appointment.
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Affiliation(s)
- Saumya S Sao
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Jessica N Coleman
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Rimel N Mwamba
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Godfrey A Kisigo
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; Kilimanjaro Clinical Research Institute, Moshi, Tanzania; London School of Hygiene and Tropical Medicine, London, UK
| | - Haika Osaki
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania; University of Copenhagen, Copenhagen, Denmark
| | - Jenny Renju
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania; London School of Hygiene and Tropical Medicine, London, UK
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Kumar P, Das C, Das U, Kumar A, Priyam N, Ranjan V, Sahu D, Rai SK, Godbole SV, Arumugam E, PVM L, Dutta S, Devi HS, Pandey A, Reddy DCS, Mehendale S, Rajan S. Augmenting progress on the elimination of vertical transmissions of HIV in India: Insights from Spectrum-based HIV burden estimations. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002270. [PMID: 37556441 PMCID: PMC10411776 DOI: 10.1371/journal.pgph.0002270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
The government of India has adopted the elimination of vertical transmission of HIV as one of the five high-level goals under phase V of the National AIDS and STD Control Programme (NACP). In this paper, we present the data from HIV estimations 2021 for India and select States detailing the progress as well as the attributable causes for vertical transmissions. The NACP spearheads work on mathematical modelling to estimate HIV burden based on the periodically conducted sentinel surveillance for guiding program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2021, we analysed the mother-to-child transmission (MTCT) during the perinatal and postnatal (breastfeeding) period. In 2021, overall, around 5,000 [3,000-7,800] vertical transmissions were estimated nationally with 58% being perinatal infections and remaining during breastfeeding. MTCT at 6 weeks was around 12.95% [9.45-16.02] with the final transmission rate at 24.25% [18.50-29.50]. Overall, 57% of vertical transmissions were among HIV-positive mothers who did not receive ART during pregnancy or breastfeeding, 19% among mothers who dropped off ART during pregnancy or delivery, and 18% among mothers who were infected during pregnancy or breastfeeding. There were significant variations between States. Depending upon the States, the programme needs to focus on the intervention domains of timely engagement in antenatal care-HIV testing-ART initiation as well as programme retention and adherence support. Equally important would be strengthening the strategic information to generate related evidence for inputting India and State-specific parameters improving the MTCT-related modelled estimates.
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Affiliation(s)
- Pradeep Kumar
- National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India
| | - Chinmoyee Das
- National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India
| | - Udayabhanu Das
- National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India
| | - Arvind Kumar
- National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India
| | - Nidhi Priyam
- National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India
| | - Varsha Ranjan
- Indian Council of Medical Research, National Institute of Medical Statistics, New Delhi, India
| | - Damodar Sahu
- Indian Council of Medical Research, National Institute of Medical Statistics, New Delhi, India
| | - Sanjay K. Rai
- All India Institute of Medical Sciences, New Delhi, India
| | - Sheela V. Godbole
- Indian Council of Medical Research, National AIDS Research Institute, Pune, India
| | - Elangovan Arumugam
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - Lakshmi PVM
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shanta Dutta
- Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Arvind Pandey
- Indian Council of Medical Research, National Institute of Medical Statistics, New Delhi, India
- Indian Council of Medical Research, New Delhi, India
| | | | - Sanjay Mehendale
- Indian Council of Medical Research, New Delhi, India
- PD Hinduja Hospital and Medical Research Center, Mumbai, India
| | - Shobini Rajan
- National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India
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Yang B, Sloot R, Floyd S, Awoniyi D, Griffith S, Ayles H, Fidler S, Hayes R, Vermund SH, Bock P. Brief Report: How Do We Reach Men? Offering HIV Testing in Evenings and Weekends in the HPTN 071 (PopART) Community-Based Trial in South Africa. J Acquir Immune Defic Syndr 2023; 93:300-304. [PMID: 37001128 PMCID: PMC10313787 DOI: 10.1097/qai.0000000000003197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Unknown HIV status and consequent low antiretroviral treatment coverage among men living with HIV combined with high-risk behavior is a key driver of the HIV epidemic in high-burden settings. We investigated whether conducting household visits during nontraditional shifts increased the number of men recruited for community-based HIV testing, compared with traditional weekday shifts in the HPTN 071 (PopART) trial in South Africa. METHODS We used data captured during household visits among individuals aged 15 years or older in 6 communities in South Africa from September 2016 to September 2017. Successful recruitment required community HIV care providers (CHiPs) accessing a household member and completing the study questionnaire. Linear regression analysis compared mean successful recruitments between the different shift types stratified by sex. RESULTS During 187 days, 62,455 successful household visits were completed. Recruitment of men and women was higher in weekends, for men highest on Sundays (Coef: 11.2, 95% CI: 8.7 to 13.7), for women highest on Saturdays (Coef: 11.3, 95% CI: 7.6 to 15.1), indicating a mean of 11.2 more men recruited on Sunday shifts, compared with traditional weekday shifts was similar when comparing traditional weekday shifts with nontraditional weekday shifts for both men and women. CONCLUSION Conducting household visits during the weekends led to increased recruitment for participation in the PopART intervention among both men and women. This suggests that targeting households during the weekend can be an effective and easy-to-implement strategy to increase the number of men accessed for HIV testing that can be integrated into a wide range of community-based services.
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Affiliation(s)
- Blia Yang
- Desmond Tutu TB Centre, Stellenbosch University, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Rosa Sloot
- Desmond Tutu TB Centre, Stellenbosch University, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Sian Floyd
- London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, United Kingdom
| | - Dolapo Awoniyi
- Desmond Tutu TB Centre, Stellenbosch University, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Sam Griffith
- FHI360, Durham, North Carolina, United States of America
| | - Helen Ayles
- Zambia AIDS Related Tuberculosis Project, University of Zambia, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom
| | - Sarah Fidler
- Imperial College London, Department of Infectious Disease Epidemiology, London, United Kingdom
| | - Richard Hayes
- London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, United Kingdom
| | - Sten H. Vermund
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Peter Bock
- Desmond Tutu TB Centre, Stellenbosch University, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Audet CM, Sack DE, Ndlovu GH, Morkel C, Harris J, Wagner RG, Seabi TM. Women want male partner engagement in antenatal care services: A qualitative study of pregnant women from rural South Africa. PLoS One 2023; 18:e0283789. [PMID: 37011063 PMCID: PMC10069782 DOI: 10.1371/journal.pone.0283789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION Evidence strongly shows that a supportive, involved male partner facilitates maternal HIV testing during pregnancy, increases maternal antiretroviral (ART) adherence and increases HIV-free infant survival. Partner engagement in antenatal care (ANC) is influential; however, the most effective strategy to engage male partners is currently unknown. Engaging pregnant women to understand whether male partner involvement is welcome in ANC, what this involvement entails and how best to invite their partner is an important first step in determining how best to engage male partners. METHODS We interviewed 36 pregnant women receiving ANC services at a district hospital in rural Mpumalanga, South Africa to assess the strengths and weaknesses of their current relationship, the type of partner support they receive, whether they would like their male partner to be involved in their ANC, and how best to invite their male partner to their appointments. We conducted a thematic analysis of the qualitative interviews using MAXQDA software. RESULTS Financial, emotional, and physical support were noted as important aspects of support currently provided by male partners, with most pregnant women wanting their partners to engage in ANC services during pregnancy. Preferred engagement strategies included participation in couple-based HIV testing and counseling, regular ANC appointment attendance, and delivery room presence. Women who reported a positive relationship with her partner were more likely to prefer inviting their partner without health facility assistance, while those who reported challenges in their relationship preferred assistance through a letter or community health worker. Pregnant women perceived regular business hours (due to their partner being employed and unable to take off work) and having a partner involved in multiple relationships as barriers in getting their partner to attend ANC services. DISCUSSION Rural South African women, even those in unsatisfactory relationships want their male partners to attend their ANC visits and birth. To make this possible, health facilities will have to tailor male partner engagement outreach strategies to the preferences and needs of the pregnant woman.
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Affiliation(s)
- Carolyn M. Audet
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel E. Sack
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Godfrey H. Ndlovu
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Morkel
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jacob Harris
- Notre Dame University, Notre Dame, Indiana, United States of America
| | - Ryan G. Wagner
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshegofatso M. Seabi
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sack DE, Emílio A, Graves E, Matino A, Paulo P, Aboobacar AU, De Schacht C, Audet CM. Attitudes and perceptions towards postpartum contraceptive use among seroconcordant partners with HIV in rural Mozambique: a qualitative study. Glob Health Res Policy 2023; 8:7. [PMID: 36918959 PMCID: PMC10014407 DOI: 10.1186/s41256-023-00292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/05/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Postpartum contraceptive uptake reduces short interpregnancy intervals, unintended pregnancies, and their negative sequalae: poor maternal and fetal outcomes. Healthy timing and spacing of pregnancy in people living with HIV (PLHIV) also allows time to achieve viral suppression to reduce parent-to-child HIV transmission. There is scant understanding about how couples-based interventions impact postpartum contraceptive uptake among PLHIV in sub-Saharan Africa. METHODS We interviewed 38 recently pregnant people and 26 of their partners enrolled in the intervention arm of the Homens para Saúde Mais (HoPS+) [Men for Health Plus] trial to assess their perceptions of, attitudes towards, and experiences with contraceptive use. Individuals in the HoPS+ intervention arm received joint-as opposed to individual-HIV-related services during pregnancy and postpartum periods, six counseling and skills sessions, and nine sessions with a peer support couple. Our thematic analysis of the 64 in-depth interviews generated 14 deductive codes and 3 inductive codes across themes within the Information, Motivation, and Behavior Model of health behavior change. RESULTS Participants reported accurate and inaccurate information about birth spacing and contraceptive methods. They described personal (health, economic, and religious) and social (gender norms, desired number of children) motivations for deciding whether to use contraceptives-with slightly different motivations among pregnant and non-pregnant partners. Finally, they explained the skills needed to overcome barriers to contraceptive use including how engagement in HoPS+ improved their shared decision-making skills and respect amongst partners-which facilitated postpartum contraceptive uptake. There were also several cases where non-pregnant partners unilaterally made family planning decisions despite disagreement from their partner. CONCLUSIONS These findings suggest that couples-based interventions during pregnancy and post-partum periods aimed at increasing postpartum contraceptive uptake must center pregnant partners' desires. Specifically, pregnant partners should be allowed to titrate the level of non-pregnant partner involvement in intervention activities to avoid potentially emboldening harmful gender-based intercouple decision-making dynamics.
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Affiliation(s)
- Daniel E Sack
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.
| | | | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | | | - Paula Paulo
- Friends in Global Health, Quelimane, Mozambique
| | | | | | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
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Frisby MB, Diemer MA, Sack DE, Audet CM. Dyadic Validation of Relational Processes in Seroconcordant Mozambican Couples: Social Support, Physician Trust, and Stigma. AIDS Behav 2022; 26:4135-4143. [PMID: 35689708 PMCID: PMC9940156 DOI: 10.1007/s10461-022-03739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
Psychometric instruments can quantify how people living with HIV experience three key barriers to antiretroviral therapy (ART) and retention: partner support, trust in medical professionals, and internalized HIV-related stigma. However, two challenges arise when using these instruments to measure and interpret relational processes among Mozambican couples, especially those participating in a couples intervention. First, relational measures have almost exclusively been developed and normed with Western, middle-class, and/or White adults. Second, traditional measurement approaches neglect the relational processes between partners. Using dyadic modeling, this paper demonstrates metric and scalar invariance for instruments measuring partner support (CFI = 0.964, TLI = 0.965, RMSEA = 0.034, SRMR = 0.052), trust in medical professionals (CFI = 0.978, TLI = 0.980, RMSEA = 0.033, SRMR = 0.039), and internalized HIV-related stigma (CFI = 0.960, TLI = 0.961, RMSEA = 0.050, SRMR = 0.060) within the novel context of seroconcordant HIV+ couples in Zambézia province.
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Affiliation(s)
| | | | - Daniel E Sack
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Carolyn M Audet
- Department of Health Policy and Institute for Global Health, Vanderbilt University, Nashville, TN, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) in affiliation with the School of Public Health at University of the Witwatersrand, Johannesburg, South Africa
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11
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Gessesse NA, Gela GB, Aweke AM, Balcha WF. Male partners involvement in human immune deficiency virus testing and counseling during prenatal care visits in Bichena town Westcentral Ethiopia: a cross-sectional study. BMC Res Notes 2022; 15:327. [PMID: 36266661 PMCID: PMC9583477 DOI: 10.1186/s13104-022-06215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Transmission of the Human immune deficiency virus (HIV) from mother to child remains a significant problem in developing countries. Male partners’ involvement in HIV testing and counseling is a major entry point for the prevention of mother-to-child transmission (PMTCT) of HIV. This study aimed to assess male partners’ involvement in HIV testing and counseling during prenatal care visits in Bichena town, Westcentral Ethiopia. Results A community-based cross-sectional study design was conducted from October 1/2018 to June 15/2019 among 406 male partners. Less than half (41.38%) [95% CI: 36.20–46.10%] of the male partners were involved in HIV testing and counseling. In multivariable analysis male partners who are found in the age group of 20–29 years, secondary, and diploma and above educational level, good knowledge of the services provided in the prenatal care visits, male partners whose wife had ≥ 4 prenatal care visits, good knowledge of mother to child transmission (MTCT) and PMTCT of HIV, entering the prenatal care room together with his wife, discussing maternal health issue with health care providers, and travel < 15 min to reach a nearby health facility were associated with male partners involvement in HIV testing and counseling. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06215-9.
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Affiliation(s)
- Nigusu Ayalew Gessesse
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, P.Box:079, Bahir Dar, Ethiopia
| | - Getahun Belay Gela
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, P.Box:079, Bahir Dar, Ethiopia
| | - Amlaku Mulat Aweke
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, P.Box:079, Bahir Dar, Ethiopia
| | - Wondu Feyisa Balcha
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, P.Box:079, Bahir Dar, Ethiopia.
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Couples-based interventions and postpartum contraceptive uptake: A systematic review. Contraception 2022; 112:23-36. [PMID: 35577147 PMCID: PMC9968552 DOI: 10.1016/j.contraception.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Systematically review the existing evidence about couples-based interventions and postpartum contraceptive uptake and generate recommendations for future research. DATA SOURCES PubMed, Web of Science, PsycINFO, Embase, and CINAHL through June 7, 2021. STUDY SELECTION AND DATA EXTRACTION Studies with a couples-based intervention assessing postpartum contraceptive uptake. Two independent reviewers screened studies, extracted data, and assessed risk of bias with RoB-2 (Cochrane Risk of Bias 2) for randomized and ROBINS-I (Risk of Bias in Non-Randomized Studies - Interventions) for observational studies. Data were synthesized in tables, figures, and a narrative review. RESULTS A total of 925 papers were identified, 66 underwent full text review, and 17 articles, which included 18 studies - 16 randomized, 2 observational - were included. The lack of intervention and outcome homogeneity precluded meta-analysis and isolating the effect of partner involvement. Four studies were partner-required, where partner involvement was a required component of the intervention, and 14 were partner-optional. Unadjusted risk differences ranged from 0.01 to 0.51 in favor of couples-based interventions increasing postpartum contraceptive uptake versus standard of care. Bias assessment of the 16 randomized studies classified 8, 3, and 5 studies as at a high, some concern, and low risk of bias. Common sources of bias included intervention non-adherence and missing outcome data. One observational study was at a high and the other at a low risk of bias. CONCLUSIONS Future studies that assess couples-based interventions must clearly define and measure how partners are involved in the intervention and assess how intervention adherence impacts postpartum contraceptive uptake.
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Temelkovska T, Kalande P, Udedi E, Bruns L, Mulungu S, Hubbard J, Gupta S, Richter L, Coates TJ, Dovel K. Men care too: a qualitative study examining women's perceptions of fathers' engagement in early childhood development (ECD) during an ECD program for HIV-positive mothers in Malawi. BMJ Open 2022; 12:e056976. [PMID: 35840298 PMCID: PMC9295663 DOI: 10.1136/bmjopen-2021-056976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Integrated early childhood development (ECD) and prevention of mother-to-child transmission (PMTCT) interventions rarely target fathers, a missed opportunity given existing research demonstrating that father involvement improves maternal and child outcomes. We aimed to explore mother's perceptions of fathers' buy-in to an integrated PMTCT-ECD programme, any impact the programme had on couple dynamics, and perceived barriers to fathers' involvement in ECD activities. DESIGN Qualitative study using individual in-depth interviews with mothers participating in a PMTCT-ECD programme. Interviews assessed mothers' perceptions of father buy-in and engagement in the programme and ECD activities. Data were coded using inductive and deductive strategies and analysed using constant comparison methods in Atlas.ti V.1.6. SETTING Four health facilities in Malawi where PMTCT services were provided. PARTICIPANTS Study participants were mothers infected with HIV who were enrolled in the PMTCT-ECD programme for >6 months. INTERVENTIONS The PMTCT-ECD intervention provided ECD education and counselling sessions during routine PMTCT visits for mothers infected with HIV and their infants (infant age 1.5-24 months). The intervention did not target fathers, but mothers were encouraged to share information with them. RESULTS Interviews were conducted with 29 mothers. Almost all mothers discussed the PMTCT-ECD intervention with male partners. Most mothers reported that fathers viewed ECD as valuable and practised ECD activities at home. Several reported improved partner relationships and increased communication due to the intervention. However, most mothers believed fathers would not attend the PMTCT-ECD intervention due to concerns regarding HIV-related stigma at PMTCT clinics, time required to attend and perceptions that the intervention was intended for women. CONCLUSIONS Fathers were interested in an integrated PMTCT-ECD programme and actively practised ECD activities at home, but felt uncomfortable visiting PMTCT clinics. Interventions should consider direct community outreach or implementing ECD programmes at facility entry points where men frequent, such as outpatient departments.
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Affiliation(s)
- Tijana Temelkovska
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Pericles Kalande
- Implementation Science Department, Partners in Hope Medical Center, Lilongwe, Malawi
| | - Evelyn Udedi
- Implementation Science Department, Partners in Hope Medical Center, Lilongwe, Malawi
| | - Laurie Bruns
- Global Health Institute, University of California Los Angeles, Los Angeles, California, USA
| | - Siyenunu Mulungu
- Implementation Science Department, Partners in Hope Medical Center, Lilongwe, Malawi
| | - Julie Hubbard
- Implementation Science Department, Partners in Hope Medical Center, Lilongwe, Malawi
- Division of Infectious Diseases, University of California Los Angeles, Los Angeles, California, USA
| | - Sundeep Gupta
- Division of Infectious Diseases, University of California Los Angeles, Los Angeles, California, USA
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Linda Richter
- Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Thomas J Coates
- Division of Infectious Diseases, University of California Los Angeles, Los Angeles, California, USA
- University of California Global Health Institute, San Francisco, California, USA
| | - Kathryn Dovel
- Implementation Science Department, Partners in Hope Medical Center, Lilongwe, Malawi
- Division of Infectious Diseases, University of California Los Angeles, Los Angeles, California, USA
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14
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Triulzi I, Ciccacci F, Palla I, Mthiko B, Thole D, Marazzi MC, Palombi L, Turchetti G, Orlando S. Improving Male Partner Involvement in HIV-Positive Women's Care Through Behavioral Change Interventions in Malawi (WeMen Study): A Prospective, Controlled Before-and-After Study. Front Public Health 2022; 10:864489. [PMID: 35875033 PMCID: PMC9305193 DOI: 10.3389/fpubh.2022.864489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
Several strategies and interventions have been implemented to improve male partner involvement (MI) in Sub-Saharan Africa, but evidence on successful interventions is scarce. This controlled before-and-after intervention study aims to evaluate the impact of three interventions on male partners' involvement in HIV+ women's care in Malawi. We piloted these three interventions: the organization of a special day for men, the deployment of male champions in communities to increase awareness on MI, and the delivery of an incentive (food package) for couples attending the facility. We observed a significant increase in the number of women accompanied by their partners (from 48.5 to 81.4%) and the number of women feeling safe at home (from 63.5 to 95.2%) after the special day intervention. This outcome increased after the deployment of male champions in communities (from 44.0 to 75.0%). No significant improvement was observed in the site where we delivered the incentive to couples. Our findings showed that the special day for men and the use of male champions might effectively increase the male involvement in the health of their female partners.
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Affiliation(s)
- Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Fausto Ciccacci
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Bryan Mthiko
- DREAM Programme, Community of Sant'Egidio, Balaka, Malawi
| | | | | | - Leonardo Palombi
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | | | - Stefano Orlando
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
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15
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Tobin KE, Heidari O, Winiker A, Pollock S, Rothwell MD, Alexander K, Owczarzak J, Latkin C. Peer Approaches to Improve HIV Care Cascade Outcomes: a Scoping Review Focused on Peer Behavioral Mechanisms. Curr HIV/AIDS Rep 2022; 19:251-264. [PMID: 35798989 DOI: 10.1007/s11904-022-00611-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW There are three main components of peer-based approaches regardless of type: education, social support, and social norms. The purpose of this scoping review was to examine evidence in the literature among peer-based interventions and programs of components and behavioral mechanisms utilized to improve HIV care cascade outcomes. RECENT FINDINGS Of 522 articles found, 40 studies were included for data abstraction. The study outcomes represented the entire HIV care cascade from HIV testing to viral suppression. Most were patient navigator models and 8 of the studies included all three components. Social support was the most prevalent component. Role modeling of behaviors was less commonly described. This review highlighted the peer behavioral mechanisms that operate in various types of peer approaches to improve HIV care and outcomes in numerous settings and among diverse populations. The peer-based approach is flexible and commonly used, particularly in resource-poor settings.
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Affiliation(s)
- Karin E Tobin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Omeid Heidari
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Abigail Winiker
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sarah Pollock
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Melissa Davey Rothwell
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jill Owczarzak
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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16
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Audet CM, Pettapiece-Phillips M, Tian Y, Shepherd BE, Vermund SH, Salato J. "If it weren't for my traditional healer, I would be dead": Engaging traditional healers to support people living with HIV in rural Mozambique. PLoS One 2022; 17:e0270565. [PMID: 35763519 PMCID: PMC9239464 DOI: 10.1371/journal.pone.0270565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Across rural sub-Saharan Africa, people living with HIV (PLHIV) commonly seek out treatment from traditional healers. We report on the clinical outcomes of a community health worker intervention adapted for traditional healers with insight into our results from qualitative interviews. We employed a pre-post intervention study design and used sequential mixed methods to assess the impact of a traditional healer support worker intervention in Zambézia province, Mozambique. After receiving a positive test result, 276 participants who were newly enrolled in HIV treatment and were interested in receiving home-based support from a traditional healer were recruited into the study. Those who enrolled from February 2016 to August 2016 received standard of care services, while those who enrolled from June 2017 to May 2018 received support from a traditional healer. We conducted interviews among healers and participants to gain insight into fidelity of study activities, barriers to support, and program improvement. Medication possession ratio at home (based on pharmacy pick-up dates) was not significantly different between pre- and post-intervention participants (0.80 in the pre-intervention group compared to 0.79 in the post-intervention group; p = 0.96). Participants reported receiving educational and psychosocial support from healers. Healers adapted their support protocol to initiate directly observed therapy among participants with poor adherence. Traditional healers can provide community-based psychosocial support, education, directly observed therapy, and disclosure assistance for PLHIV. Multiple factors may hinder patients' desire and ability to remain adherent to treatment, including poverty, confusion about medication side effects, and frustration with wait times at the health facility.
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Affiliation(s)
- Carolyn M. Audet
- Department of Health Policy, Vanderbilt University, Nashville, TN, United States of America
| | | | - Yuqi Tian
- Department of Biostatistics, Vanderbilt University, Nashville, TN, United States of America
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, TN, United States of America
| | - Sten H. Vermund
- School of Public Health, Yale University, New Haven, CT, United States of America
| | - Jose Salato
- Friends in Global Health, Quelimane, Mozambique
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17
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Retention in care and viral suppression in the PMTCT continuum at a large referral facility in western Kenya. AIDS Behav 2022; 26:3494-3505. [PMID: 35467229 PMCID: PMC9550706 DOI: 10.1007/s10461-022-03666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/20/2022]
Abstract
Medical records of pregnant and postpartum women living with HIV and their infants attending a large referral facility in Kenya from 2015 to 2019 were analyzed to identify characteristics associated with retention in care and viral suppression. Women were stratified based on the timing of HIV care enrollment: known HIV-positive (KHP; enrolled pre-pregnancy) and newly HIV-positive (NHP; enrolled during pregnancy). Associations with retention at 18 months postpartum and viral suppression (< 1000 copies/mL) were determined. Among 856 women (20% NHP), retention was 83% for KHPs and 53% for NHPs. Viral suppression was 88% for KHPs and 93% for NHPs, but 19% of women were missing viral load results. In a competing risk model, viral suppression increased by 18% for each additional year of age but was not associated with other factors. Overall, 1.9% of 698 infants with ≥ 1 HIV test result were HIV-positive. Tailored interventions are needed to promote retention and viral load testing, particularly for NHPs, in the PMTCT continuum.
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18
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Sasse SA, Harrington BJ, DiPrete BL, Chagomerana MB, Klyn LL, Wallie SD, Maliwichi M, Jumbe AN, Hoffman IF, Rosenberg NE, Tang JH, Hosseinipour MC. Factors associated with a history of treatment interruption among pregnant women living with HIV in Malawi: A cross-sectional study. PLoS One 2022; 17:e0267085. [PMID: 35439264 PMCID: PMC9017884 DOI: 10.1371/journal.pone.0267085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/02/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Long-term care engagement of women on antiretroviral therapy (ART) is essential to effective HIV public health measures. We sought to explore factors associated with a history of HIV treatment interruption among pregnant women living with HIV presenting to an antenatal clinic in Lilongwe, Malawi.
Methods
We performed a cross-sectional study of pregnant women living with HIV who had a history of ART interruption presenting for antenatal care. Women were categorized as either retained in HIV treatment or reinitiating care after loss-to-follow up (LTFU). To understand factors associated with treatment interruption, we surveyed socio-demographic and partner relationship characteristics. Crude and adjusted prevalence ratios (aPR) for factors associated with ART interruption were estimated using modified Poisson regression with robust variance. We additionally present patients’ reasons for ART interruption.
Results
We enrolled 541 pregnant women living with HIV (391 retained and 150 reinitiating). The median age was 30 years (interquartile range (IQR): 25–34). Factors associated with a history of LTFU were age <30 years (aPR 1.46; 95% CI: 1.33–1.63), less than a primary school education (aPR 1.25; CI: 1.08–1.46), initiation of ART during pregnancy or breastfeeding (aPR 1.49, CI: 1.37–1.65), nondisclosure of HIV serostatus to their partner (aPR 1.39, CI: 1.24–1.58), lack of awareness of partner’s HIV status (aPR 1.41, CI: 1.27–1.60), and no contraception use at conception (aPR 1.60, CI 1.40–1.98). Access to care challenges were the most common reasons reported by women for treatment interruption (e.g., relocation, transport costs, or misplacing health documentation).
Conclusions
Interventions that simplify the ART clinic transfer process, facilitate partner disclosure, and provide counseling about the importance of lifelong ART beyond pregnancy and breastfeeding should be further evaluated for improving retention in ART treatment of women living with HIV in Malawi.
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Affiliation(s)
- Simone A. Sasse
- Department of Obstetrics and Gynecology, New York University, New York, New York, United States of America
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- * E-mail:
| | - Bryna J. Harrington
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Bethany L. DiPrete
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | | | - Laura Limarzi Klyn
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Shaphil D. Wallie
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Madalitso Maliwichi
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Allan N. Jumbe
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Irving F. Hoffman
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Nora E. Rosenberg
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Jennifer H. Tang
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Mina C. Hosseinipour
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
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Carlucci JG, De Schacht C, Graves E, González P, Bravo M, Yu Z, Amorim G, Arinze F, Silva W, Tique JA, Alvim MFS, Simione B, Fernando AN, Wester CW. CD4 Trends With Evolving Treatment Initiation Policies Among Children Living With HIV in Zambézia Province, Mozambique, 2012-2018. J Acquir Immune Defic Syndr 2022; 89:288-296. [PMID: 34840319 PMCID: PMC8826612 DOI: 10.1097/qai.0000000000002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Historically, antiretroviral therapy (ART) initiation was based on CD4 criteria, but this has been replaced with "Test and Start" wherein all people living with HIV are offered ART. We describe the baseline immunologic status among children relative to evolving ART policies in Mozambique. METHODS This retrospective evaluation was performed using routinely collected data. Children living with HIV (CL aged 5-14 years) with CD4 data in the period of 2012-2018 were included. ART initiation "policy periods" corresponded to implementation of evolving guidelines: in period 1 (2012-2016), ART was recommended for CD4 <350 cells/mm3; during period 2 (2016-2017), the CD4 threshold increased to <500 cells/mm3; Test and Start was implemented in period 3 (2017-2018). We described temporal trends in the proportion of children with severe immunodeficiency (CD4 <200 cells/mm3) at enrollment and at ART initiation. Multivariable regression models were used to estimate associations with severe immunodeficiency. RESULTS The cohort included 1815 children with CD4 data at enrollment and 1922 at ART initiation. The proportion of children with severe immunodeficiency decreased over time: 20% at enrollment into care in period 1 vs. 16% in period 3 (P = 0.113) and 21% at ART initiation in period 1 vs. 15% in period 3 (P = 0.004). Children initiating ART in period 3 had lower odds of severe immunodeficiency at ART initiation compared with those in period 1 [adjusted odds ratio (aOR) = 0.67; 95% CI: 0.51 to 0.88]. Older age was associated with severe immunodeficiency at enrollment (aOR = 1.13; 95% CI: 1.06 to 1.20) and at ART initiation (aOR = 1.14; 95% CI: 1.08 to 1.21). CONCLUSIONS The proportion of children with severe immunodeficiency at ART initiation decreased alongside more inclusive ART initiation guidelines. Earlier treatment of children living with HIV is imperative.
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Affiliation(s)
- James G. Carlucci
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Infectious Diseases, Nashville, TN
- Vanderbilt University Medical Center, Institute for Global Health, Nashville, TN
| | | | - Erin Graves
- Vanderbilt University Medical Center, Institute for Global Health, Nashville, TN
| | | | | | - Zhihong Yu
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN;
| | - Gustavo Amorim
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN;
| | | | | | | | | | - Beatriz Simione
- Ministry of Health, National Directorate of Public Health, Maputo, Mozambique;
| | | | - C. William Wester
- Vanderbilt University Medical Center, Institute for Global Health, Nashville, TN
- Vanderbilt University Medical Center, Department of Medicine, Division of Infectious Diseases, Nashville, TN
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20
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Montandon M, Efuntoye T, Itanyi IU, Onoka CA, Onwuchekwa C, Gwamna J, Schwitters A, Onyenuobi C, Ogidi AG, Swaminathan M, Oko JO, Ijaodola G, Odoh D, Ezeanolue EE. Improving uptake of prevention of mother-to-child HIV transmission services in Benue State, Nigeria through a faith-based congregational strategy. PLoS One 2021; 16:e0260694. [PMID: 34855849 PMCID: PMC8638953 DOI: 10.1371/journal.pone.0260694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Nigeria has low antiretroviral therapy (ART) coverage among HIV-positive pregnant women. In a previous cluster-randomized trial in Nigeria, Baby Shower events resulted in higher HIV testing coverage and linkage of pregnant women to ART; here, we assess outcomes of Baby Shower events in a non-research setting. Methods Baby Shower events, including a prayer ceremony, group education, music, gifting of a “mama pack” with safe delivery supplies, and HIV testing with ART linkage support for HIV-positive pregnant women, were conducted in eighty sites in Benue State, Nigeria. Client questionnaires (including demographics, ANC attendance, and HIV testing history), HIV test results, and reported linkage to ART were analyzed. Descriptive data on HIV testing and ART linkage data for facility-based care at ANC clinics in Benue State were also analyzed for comparison. Results Between July 2016 and October 2017, 10,056 pregnant women and 6,187 male partners participated in Baby Shower events; 61.5% of women attended with a male partner. Nearly half of female participants (n = 4515, 44.9%) were not enrolled in ANC for the current pregnancy, and 22.3% (n = 2,241) of female and 24.8% (n = 1,532) of male participants reported they had never been tested for HIV. Over 99% (n = 16,240) of participants had their HIV status ascertained, with 7.2% of females (n = 724) and 4.0% of males (n = 249) testing HIV-positive, and 2.9% of females (n = 274) and 2.3% of males (n = 138) receiving new HIV-positive diagnoses. The majority of HIV-positive pregnant women (93.0%, 673/724) were linked to ART. By comparison, at health facilities in Benue State during a similar time period, 99.7% of pregnant women had HIV status ascertained, 8.4% had a HIV-positive status, 2.1% were newly diagnosed HIV-positive, and 100% were linked to ART. Conclusion Community-based programs such as the faith-based Baby Shower intervention complement facility-based approaches and can reach individuals who would not otherwise access facility-based care. Future Baby Showers implementation should incorporate enhanced support for ART linkage and retention to maximize the impact of this intervention on vertical HIV transmission.
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Affiliation(s)
- Michele Montandon
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Timothy Efuntoye
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Ijeoma U. Itanyi
- University of Nigeria Center for Translation and Implementation Research, Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chima A. Onoka
- University of Nigeria Center for Translation and Implementation Research, Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - Jerry Gwamna
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Amee Schwitters
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Chibuzor Onyenuobi
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Amaka G. Ogidi
- University of Nigeria Center for Translation and Implementation Research, Nsukka, Enugu, Nigeria
| | - Mahesh Swaminathan
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | | | - Gbenga Ijaodola
- Nigeria Federal Ministry of Health, National AIDS and STI Control Program, Abuja, Federal Capital Territory, Nigeria
| | - Deborah Odoh
- Nigeria Federal Ministry of Health, National AIDS and STI Control Program, Abuja, Federal Capital Territory, Nigeria
| | - Echezona E. Ezeanolue
- University of Nigeria Center for Translation and Implementation Research, Nsukka, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, United States of America
- Department of Pediatrics and Child Health, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
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21
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Sharkey T, Wall KM, Parker R, Tichacek A, Pappas-DeLuca KA, Kilembe W, Inambao M, Malama K, Hoagland A, Peeling R, Allen S. A cluster randomized trial to reduce HIV risk from outside partnerships in Zambian HIV-Negative couples using a novel behavioral intervention, "Strengthening Our Vows": Study protocol and baseline data. Contemp Clin Trials Commun 2021; 24:100850. [PMID: 34622087 PMCID: PMC8481973 DOI: 10.1016/j.conctc.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/02/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Heterosexual couples contribute to most new HIV infections in areas of generalized HIV epidemics in sub-Saharan Africa. After Couples' Voluntary HIV Counseling and Testing (CVCT), heterosexual concordant HIV negative couples (CNC) in cohabiting unions contribute to approximately 47% of residual new infections in couples. These infections are attributed to concurrent sexual partners, a key driver of the HIV epidemic in Zambia. METHODS/DESIGN Ten Zambian government clinics in two of the largest cities were randomized in matched pairs to a Strengthening Our Vows (SOV) intervention or a Good Health Package (GHP) comparison arm. SOV addressed preventing HIV infection from concurrent partners and protecting spouses after exposures outside the relationship. GHP focused on handwashing; water chlorination; household deworming; and screening for hypertension, diabetes and schistosomiasis. CNC were referred from CVCT services in government clinics. Follow-up includes post-intervention questionnaires and outcome assessments through 60 months. Longitudinal outcomes of interest include self-report and laboratory markers of condomless sex with outside partners and reported sexual agreements. We present baseline characteristics and factors associated with study arm and reported risk using descriptive statistics. RESULTS The mean age of men was 32 and 26 for women. On average, couples cohabited for 6 years and had 2 children. Baseline analyses demonstrated some failures of randomization by study arm which will be considered in future primary analyses of longitudinal data. An HIV/STI risk factor composite was not different in the two study arms. Almost one-quarter of couples had an HIV risk factor at baseline. DISCUSSION In preparation for future biomedical and behavioral interventions in sub-Saharan Africa, it is critical to understand and decrease HIV risk within CNC.
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Affiliation(s)
- Tyronza Sharkey
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- London School of Hygiene and Tropical Medicine, UK
| | - Kristin M. Wall
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Katina A. Pappas-DeLuca
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - William Kilembe
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Mubiana Inambao
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Kalonde Malama
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Alexandra Hoagland
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | | | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
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22
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Jeremiah RD, Patel DR, Chirwa E, Kapito E, Mei X, McCreary LL, Norr KF, Liu L, Patil CL. A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania. BMC Pregnancy Childbirth 2021; 21:790. [PMID: 34819018 PMCID: PMC8611988 DOI: 10.1186/s12884-021-04267-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. METHODS A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. RESULTS Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. CONCLUSIONS HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.
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Affiliation(s)
- Rohan D Jeremiah
- College of Nursing, University of Illinois Chicago, Chicago, USA.
| | - Dhruvi R Patel
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Ellen Chirwa
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Esnath Kapito
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Xiaohan Mei
- School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Linda L McCreary
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Kathleen F Norr
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Li Liu
- School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Crystal L Patil
- College of Nursing, University of Illinois Chicago, Chicago, USA
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Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010751. [PMID: 34682492 PMCID: PMC8535610 DOI: 10.3390/ijerph182010751] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/31/2022]
Abstract
In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President’s Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.
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Mushamiri I, Belai W, Sacks E, Genberg B, Gupta S, Perry HB. Evidence on the effectiveness of community-based primary health care in improving HIV/AIDS outcomes for mothers and children in low- and middle-income countries: Findings from a systematic review. J Glob Health 2021; 11:11001. [PMID: 34327001 PMCID: PMC8284540 DOI: 10.7189/jogh.11.11001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The effectiveness of community-based primary health care (CBPHC) interventions in low- and middle-income countries (LMICs), especially for maternal, neonatal and child health, is well established. However, there has not been a systematic review of the literature on the effectiveness of CBPHC on HIV outcomes derived from rigorous assessments of primary studies. Using peer-reviewed studies of randomized interventions or those containing a specified control group and directly measuring clinical HIV outcomes, we provide evidence for the effectiveness of CBPHC on HIV outcomes for mothers and children in low- and middle-income countries (LMICs). METHODS Eligibility criteria included studies assessing the effectiveness of community-based HIV interventions with or without a facility-based component, or multiple integrated projects, with outcome measures defining an aspect of HIV health status such as the utilization of prevention or health care services, nutritional status, serious morbidity (including clinical measures of HIV progression) or mortality of children aged five or younger and pregnant women. Articles published through June 3, 2020 were identified by searching four databases. The type of community-based projects implemented, the implementors, and the implementation strategies of each program were identified and the impact on HIV-related outcomes assessed. RESULTS The search yielded 10 537 articles; 4881 underwent title and abstract screening after removing duplicates. Of these, 117 studies qualified for full-text screening; only 22 were included in the final analysis. Most studies showed that community-based interventions improved HIV prevention and treatment outcomes compared to facility-based approaches alone. Each study had at least one statistically significant HIV-related outcome; the non-significant outcomes found in six of the 22 studies were mostly not related to HIV programming. Most interventions were implemented by community health workers; other implementers were government workers, community members, or research staff. Strategies used included peer-to-peer education, psychosocial support, training of community champions, community-based follow-up care, home-based care, and integrated care. CONCLUSIONS CBPHC strategies are effective in improving population-based, HIV-related health outcomes for mothers and children, especially in combination with facility-based approaches. However, there is a need to assess the scalability of such interventions and integrate them into existing health systems to assess their impact on the HIV pandemic in more routine settings.
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Affiliation(s)
- Ivy Mushamiri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Wintana Belai
- Department of International Health, Division of Health Systems, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emma Sacks
- Department of International Health, Division of Health Systems, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Becky Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sundeep Gupta
- University of California at Los Angeles, Los Angeles, California, USA
| | - Henry B Perry
- Department of International Health, Division of Health Systems, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Daniele MAS. Male partner participation in maternity care and social support for childbearing women: a discussion paper. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200021. [PMID: 33938279 PMCID: PMC8090816 DOI: 10.1098/rstb.2020.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 12/28/2022] Open
Abstract
Male partners/fathers are key support persons for many childbearing women and their involvement in pregnancy, childbirth and the postpartum/postnatal period has beneficial effects on a wide range of outcomes related to maternal and child health and family wellbeing. Social support is implicated in the relevant causal pathway, but has received largely tangential attention in the public health literature. This discussion paper aims to reframe men's participation in maternity care as an opportunity to enhance their readiness and ability to provide social support to women, contributing to the debate on the definition and rationale for male partner involvement, and paving the way for further empirical work. I begin by presenting a theory of change illustrating the causal pathway leading from male partner participation, through the key intermediate step of social support, to improved health and wellbeing for women and children. I proceed by arguing that many people desire male partner participation in maternity care; however, in practice, this is often limited owing to cultural, social and institutional barriers. I use examples from the intervention literature to demonstrate how participation in care can boost men's motivation to support women and enhance their ability to do so by increasing their knowledge and skills. Finally, I draw up general implications for further male partner involvement programmes, suggesting that in order to achieve meaningful and sustainable gains, attention to design is crucial in order to avoid reinforcing patriarchal gender norms. Programmes should be implemented alongside other efforts to improve quality and promote woman-centred care. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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What has comprehensive HIV/AIDS knowledge got to do with HIV testing among men in Kenya and Mozambique? Evidence from Demographic and Health Surveys. J Biosoc Sci 2021; 54:558-571. [PMID: 34099074 DOI: 10.1017/s0021932021000237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
People living with undiagnosed HIV are big contributors to the transmission of the virus. Although measures have been made to scale up HIV prevention and voluntary counselling and testing in sub-Saharan Africa, testing coverage remains low in many sub-Saharan African countries, including Mozambique and Kenya, where most people live with HIV/AIDS. Studies have shown that, in most countries in sub-Saharan Africa, men are less likely to test for HIV compared with women. This study examined the relationship between comprehensive HIV/AIDS knowledge and HIV testing among men in Kenya and Mozambique. Data were from the men's re-code file of the Demographic and Health Surveys of Mozambique and Kenya. Binary logistic regression models were generated and the results presented as crude odds ratios (cOR) and adjusted odds ratios (aOR). The prevalences of HIV testing in Kenya and Mozambique were 80.1% and 46.7%, respectively. Men in Mozambique who had comprehensive HIV/AIDS knowledge (aOR=1.26, CI: 1.07-1.47) were more likely to test for HIV compared with their counterparts who had no comprehensive HIV/AIDS knowledge. In Kenya, men who had comprehensive HIV/AIDS knowledge (aOR=1.23, CI: 1.09-1.39) were more likely to test for HIV compared with their counterparts who had no comprehensive HIV/AIDS knowledge. This study found a statistically strong significant association between comprehensive HIV/AIDS knowledge and HIV testing among men in Kenya and Mozambique. To improve HIV testing rate among men, it is important that interventions are geared towards improving men's comprehensive HIV/AIDS knowledge, perhaps by expanding HIV/AIDS education programmes and campaigns. This could improve HIV testing rates and ensure the realization of the global HIV/AIDS target of 95-95-95 by the year 2030.
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Ahonkhai AA, Aliyu MH, Audet CM, Bravo M, Simmons M, Claquin G, Memiah P, Fernando AN, Carlucci JG, Shepherd BE, Van Rompaey S, Yu Z, Gong W, Vermund SH, Wester CW. Poor retention and care-related sex disparities among youth living with HIV in rural Mozambique. PLoS One 2021; 16:e0250921. [PMID: 34019582 PMCID: PMC8139489 DOI: 10.1371/journal.pone.0250921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background There are few studies that characterize sex-related differences in HIV outcomes among adolescents and young adults (AYA) 15–24 years of age. Methods We conducted a retrospective cohort study among AYA who enrolled in a comprehensive HIV program in Mozambique between 2012–2016. We assessed patients by sex and pregnancy/lactation status, comparing time to combination antiretroviral therapy (ART) initiation using Cox proportional hazard models. We employed multivariable logistic regression to investigate pre- and post-ART retention. Patients were defined as ‘retained pre-ART’ if they attended at least 3 of 4 required visits or started ART in the 6 months after enrollment, and ‘retained post-ART’ if they had any ART pickup or clinical visit during the last 90 days of the one-year follow-up period. Results Of 47,702 patients in the cohort, 81% (n = 38,511) were female and 19% (n = 9,191) were male. Of the females, 57% (n = 21,770) were non-pregnant and non-lactating (NPNL) and 43% (n = 16,741) were pregnant or lactating (PL). PL (aHR 2.64, 95%CI:2.47–2.81) and NPNL females (aHR 1.36, 95%CI:1.30–1.42) were more likely to initiate ART than males. PL females had higher odds of pre-ART retention in care (aOR 3.56, 95%CI: 3.30–3.84), as did NPNL females (aOR 1.71, 95%CI: 1.62–1.81), compared to males. This was also true for retention post-ART initiation, with higher odds for both PL (aOR 1.78, 95%CI:1.63–1.94) and NPNL females (aOR 1.50, 95%CI:1.35–1.65) compared to males. Conclusions PL females were most likely to initiate ART and remain in care post-ART in this AYA cohort, likely reflecting expansion of Option B+. Despite pregnancy and policy driven factors, we observed important sex-related disparities in this cohort. NPNL females were more likely to initiate ART and be retained in care before and after ART initiation than males. These data suggest that young males need targeted interventions to improve these important care continuum outcomes.
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Affiliation(s)
- Aima A. Ahonkhai
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Friends in Global Health (FGH), Maputo, Mozambique
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Melynda Simmons
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Gael Claquin
- Friends in Global Health (FGH), Maputo, Mozambique
| | - Peter Memiah
- Division of Epidemiology and Prevention, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - James G. Carlucci
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | | | - Zhihong Yu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Wu Gong
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Sten H. Vermund
- Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - C. William Wester
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Audet CM, Graves E, Emílio AM, Matino A, Paulo P, Aboobacar AM, Fonseca CL, Van Rompaey S, De Schacht C. Effect of a storytelling intervention on the retention of serodiscordant couples in ART/PrEP services at antenatal clinic in Namacurra province in Zambézia, Mozambique. Contemp Clin Trials Commun 2021; 22:100782. [PMID: 34095604 PMCID: PMC8167234 DOI: 10.1016/j.conctc.2021.100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 04/01/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background Sub-Saharan Africa reported 550,000 new HIV infections among women in 2018. Pregnancy and the postpartum period are associated with an increased risk of HIV acquisition (adjusted risk ratio [RR]: 2.8 during pregnancy and 4.0 in postpartum period vs. non-pregnant or postpartum women, respectively). Acquisition of HIV during pregnancy and breastfeeding increases risk of mother to child transmission. We propose to test the impact of a peer-delivered oral storytelling intervention to increase retention in, and adherence to, pre-exposure prophylaxis (PrEP)/combination antiretroviral treatment (ART) among expectant couples. Design We propose a randomized controlled trial (RCT) (35 intervention and 35 control couples) at a health facility where 11% of expectant couples were in serodiscordant relationships in 2018. Couples randomized to the storytelling arm will be visited by a two community volunteers and who successfully adhered to PrEP/ART during a recent pregnancy. This expert couple will orate to participating couples three stories (at 1, 3 and 5 weeks after study enrollment) designed to empower, educate, and establish “ideal” interpersonal communication strategies within couples/families, and support adherence practices among participants. The primary outcome among HIV-uninfected women will be adherence to PrEP at 3 months. Conclusions PrEP among at-risk pregnant women must be implemented so that high levels of adherence and retention are achievable for them and their partners. We will test our storytelling intervention to identify an optimal strategy for PrEP education and family engagement in a region with high HIV prevalence. Our results will have an impact by effectively engaging serodiscordant couples in prevention/treatment during pregnancy and beyond.
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Affiliation(s)
- Carolyn M Audet
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.,Vanderbilt University Medical Center, Department of Health Policy, 2525 West End Ave, Suite 1200, Nashville, TN, 37203, USA
| | - Erin Graves
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | - Almiro M Emílio
- Friends in Global Health, Avenida dos Trabalhadores, 424, Quelimane, Mozambique
| | - Ariano Matino
- Friends in Global Health, Avenida dos Trabalhadores, 424, Quelimane, Mozambique
| | - Paula Paulo
- Friends in Global Health, Avenida dos Trabalhadores, 424, Quelimane, Mozambique
| | - Arifo M Aboobacar
- Provincial Health Directorate, Ministry of Health, Province of Zambézia, Quelimane, Mozambique
| | - Carlota L Fonseca
- Friends in Global Health, Avenida da Maguiguana, 32 R/C, Maputo, Mozambique
| | - Sara Van Rompaey
- Friends in Global Health, Avenida da Maguiguana, 32 R/C, Maputo, Mozambique
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Orlando S, Palla I, Ciccacci F, Triulzi I, Thole D, Sangaré HM, Marazzi MC, Nielsen-Saines K, Turchetti G, Palombi L. Improving Treatment Adherence and Retention of HIV-Positive Women Through Behavioral Change Interventions Aimed at Their Male Partners: Protocol for a Prospective, Controlled Before-and-After Study. JMIR Res Protoc 2021; 10:e19384. [PMID: 33492232 PMCID: PMC7870353 DOI: 10.2196/19384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND According to the World Health Organization, in 2018, 37.9 million people were living with HIV globally. More than two-thirds were residing in sub-Saharan Africa, where the HIV prevalence in the adult population (aged 15-49 years) was 3.9%. This population included 1.3 million pregnant women, of whom 82% had received antiretroviral therapy (ART) for the prevention of HIV mother-to-child transmission. In these countries, one challenge is an insufficient level of treatment adherence, particularly in HIV-positive pregnant women. Among the causes, the lack of involvement from a male partner is a significant contributor to the problem. This issue has strongly emerged in Malawi, one of the countries with the highest HIV prevalence in the world: 9.2% of its adult population were living with HIV in 2018. OBJECTIVE This study aims to assess 3 interventions that are aimed at improving ART adherence and retention among HIV-positive women through engagement with their male partners in 4 Malawian health care centers. METHODS The prospective, controlled before-and-after study is conducted in 3 phases (total duration: 24 months): preintervention, intervention, and postintervention analyses. The number of selected clusters (clinical centers) is limited to 4: one for each intervention, plus a cluster where no intervention is performed (control arm). The interventions are as follows: opening the facility on one Saturday per month only for men, defined as a special day; testing peer-to-peer counseling among men, male champions; and providing a noneconomic incentive to all women who are accompanied by their partners to the facility, nudge. The primary outcome of the study is to evaluate the differences in retention in care and adherence to therapeutic protocols among women; the intermediate outcome is the assessment of differences in male involvement. The level of male involvement in the health of their partners (intermediate outcome) will be evaluated through a dedicated questionnaire administered at baseline and in the postintervention phase. Data will be collected at the clinical centers and stored in 2 electronic databases managed using 2 different types of software. RESULTS The analysis of data collected in the 4 centers during the preintervention phase is ongoing, as enrollment ended on March 31, 2020. The total number of patients enrolled was 452 (Namandanje: 133; Kapeni: 78; Kapire: 75; and Balaka: 166). Meanwhile, several meetings have been conducted to organize the intervention phase. CONCLUSIONS The study will identify the best intervention that enhances the involvement of male partners in women's health, using an approach that considers a broad spectrum of behaviors. An important aspect is the use of educational tools focused on messages, thereby initiating a reflective discussion of stereotypes and false beliefs related to the idea of masculinity present in the Malawian culture. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19384.
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Affiliation(s)
- Stefano Orlando
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, PIsa, Italy
| | - Fausto Ciccacci
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, PIsa, Italy
| | | | | | | | - Karin Nielsen-Saines
- David Geffen UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Leonardo Palombi
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
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Muchie A, Getahun FA, Bekele YA, Samual T, Shibabaw T. Magnitudes of post-abortion family planning utilization and associated factors among women who seek abortion service in Bahir Dar Town health facilities, Northwest Ethiopia, facility-based cross-sectional study. PLoS One 2021; 16:e0244808. [PMID: 33471864 PMCID: PMC7817005 DOI: 10.1371/journal.pone.0244808] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Globally an estimated 55.9 million abortions occur each year. The majority of abortions occur due to unintended pregnancies, which is a result of the non-use of family planning methods. World health organization recommends all clients to utilize modern contraceptive methods after any abortion procedure. However, post-abortion family planning utilization is still low in Ethiopia including the study area. Therefore, this study was expected to determine the utilization of post-abortion family planning and associated factors in Bahir Dar city health facilities in Northwest Ethiopia. METHOD Institution based cross-sectional study was conducted among 408 women from March 1 to April 30, 2019. Data were collected through face-to-face interview using a structured and pre-tested questionnaire. Systematic random sampling was used to select the study participants. Data were cleaned, coded, and entered into epi data and exported to SPSS for further analysis. Both bivariable and multivariable logistic regression were employed. Those variables that had a p-value of less than 0.2 during the bivariate analysis were retained for the multivariable analysis. P-value and confidence interval were used to measure the level of significance on multi-variable analysis and those variables whose P-value, less than 0.05 was considered as statistically significant. RESULTS The finding of this study showed that the magnitude of post-abortion family planning (PAFP) utilization was 61% with 95% CI (55, 65). Secondary education level(AOR, 4.58; 95% CI (1.96, 10.69)), certificate and above education level (AOR, 3.06; 95% CI (1.32, 7.08)), Manual Vacuum Aspiration(MVA) (AOR, 7.05; 95% CI (2.94, 16.90)), both medication and Manual Vacuum Aspiration (AOR, 5.34; 95% CI (2.56, 11.13)) and received Post Abortion Family Planning (PAFP) counseling (AOR, 5.99; 95% CI (3.23, 11.18)) were significantly associated with PAFP utilization. CONCLUSION Post-abortion family planning utilization in Bahir Dar health facilities was low compared with the national figure. Secondary and above educational level, respondents who were managed by Manual Vacuum Aspiration (MVA), both Manual Vacuum Aspiration (MVA) and medication and receiving Post Abortion Family Planning (PAFP) counseling were predictors of post-abortion family planning service utilization.
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Affiliation(s)
| | | | - Yibeltal Alemu Bekele
- Department of Reproductive Health and Population Studies, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tsion Samual
- Department of Environmental Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tebkew Shibabaw
- Department of Environmental Health, Bahir Dar University, Bahir Dar, Ethiopia
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Sakala D, Kumwenda MK, Conserve DF, Ebenso B, Choko AT. Socio-cultural and economic barriers, and facilitators influencing men's involvement in antenatal care including HIV testing: a qualitative study from urban Blantyre, Malawi. BMC Public Health 2021; 21:60. [PMID: 33407298 PMCID: PMC7789341 DOI: 10.1186/s12889-020-10112-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023] Open
Abstract
Background Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi. Methods Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data. Results The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10112-w.
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Affiliation(s)
- Doreen Sakala
- Public Health Group, Malawi-Liverpool-Wellcome Clinical Research Programme (MLW), Blantyre, Malawi
| | - Moses K Kumwenda
- Public Health Group, Malawi-Liverpool-Wellcome Clinical Research Programme (MLW), Blantyre, Malawi.,Helse Nord TB Initiative, College of Medicine, Blantyre, Malawi
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Bassey Ebenso
- University of Leeds, Institute of Health Sciences, Leeds, UK
| | - Augustine T Choko
- Public Health Group, Malawi-Liverpool-Wellcome Clinical Research Programme (MLW), Blantyre, Malawi.
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Brault MA, Mwinga K, Kipp AM, Kennedy SB, Maimbolwa M, Moyo P, Ngure K, Haley CA, Vermund SH. Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals? Glob Health Action 2020; 13:1732668. [PMID: 32114967 PMCID: PMC7067162 DOI: 10.1080/16549716.2020.1732668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries – Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.
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Affiliation(s)
- Marie A Brault
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Kasonde Mwinga
- Rwanda Country Office, World Health Organization, Kigali, Rwanda (Formerly, WHO African Regional Office, Brazzaville, Congo)
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.,Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen B Kennedy
- University of Liberia-Pacific Institute for Research & Evaluation (UL-PIRE) Africa Center, University of Liberia, Monrovia, Liberia
| | - Margaret Maimbolwa
- Department of Nursing Sciences, University of Zambia School of Medicine, Lusaka, Zambia
| | - Precious Moyo
- Collaborative Research Program, University of Zimbabwe-University of California, San Francisco, Harare, Zimbabwe
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Connie A Haley
- Division of Infectious Diseases and Global Medicine, University of Florida, Gainesville, FL, USA
| | - Sten H Vermund
- Office of the Dean, Yale School of Public Health, New Haven, CT, USA
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McLean KE. Men's experiences of pregnancy and childbirth in Sierra Leone: Reexamining definitions of "male partner involvement". Soc Sci Med 2020; 265:113479. [PMID: 33218892 DOI: 10.1016/j.socscimed.2020.113479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
In recent decades, global health researchers and policy makers have advocated for men's increased involvement in pregnancy and childbirth with the goal of improving maternal health outcomes. By "involvement," these actors generally refer to narrow-largely Western-definitions of participation: accompanying women to antenatal and postpartum care visits, engaging in childbirth education, or being present during delivery. However, such approaches often fail to account for the culturally valid and gendered ways in which men already are involved in supporting women's reproductive health. This study is based on participant observation, semi-structured interviews, and life histories conducted among 106 fathers in eastern Sierra Leone over the course of 2013-2016. Findings demonstrate that in Sierra Leone, where pregnancy and childbirth are considered to belong to the domain of women, men's primary role is to supply the material resources for a safe and healthy birth: a nutritious diet, transportation to healthcare facilities, medicines and supplies in the case of emergency, and the items to wash and dress the baby. While evidence suggests that gender norms are shifting to include other forms of intimate and emotional involvement, it is important to recognize existing forms of material support as valuable and essential forms of care. By restricting male involvement to biomedical notions of care, global health programs and policies risk discounting other types of socially meaningful support. Rather than disparaging young, African men for falling short of what Western organizations and researchers perceive to be "correct" behaviors, this paper attempts to highlight men's own understandings of involvement, so as to provide a more complete picture of the gendered nature of reproductive health in this context.
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Affiliation(s)
- Kristen E McLean
- International Studies Program, College of Charleston, 9 Glebe Street, Charleston, SC, 29424, USA.
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Clark J, Sweet L, Nyoni S, Ward PR. Improving male involvement in antenatal care in low and middle-income countries to prevent mother to child transmission of HIV: A realist review. PLoS One 2020; 15:e0240087. [PMID: 33057353 PMCID: PMC7561142 DOI: 10.1371/journal.pone.0240087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood Human Immunodeficiency Virus (HIV) infection occurs almost exclusively via mother to child transmission (MTCT) during pregnancy, birth, or through breastfeeding. Recent studies have shown that male involvement (MI) in antenatal care (ANC) and HIV testing, including couples voluntary counselling and testing (CVCT), increases the likelihood that women will adhere to prevention advice and comply with HIV treatment if required during their pregnancy; hence reducing the rates of MTCT of HIV. This realist review investigates how, why, when, and for whom MI in ANC works best to provide contextual advice on how MI in ANC can be best used for prevention of mother to child transmission (PMTCT) of HIV. METHODS A realist review of existing evidence was conducted. Realist review seeks to explain how and why an intervention works, or does not work, in a given context. This was completed through the five stages of realist synthesis; Eliciting the program theory, search strategy, study selection criteria, data extraction, and data analysis and synthesis. Findings are presented as context-mechanism-outcome (CMO) configurations outlining the mechanisms that work in given contexts to give an outcome. RESULTS Three CMO configurations were developed. These describe that 1) Couples in monogamous relationships have higher levels of trust, commitment and security leading to increased uptake of PMTCT programs together; 2) ANC spaces that make 'male friendly' adaptions promote normalisation of MI in PMTCT and are more welcoming, leading to increased willingness of male partners to participate in ANC; and 3) couples and communities with higher health literacy encourage increased informed decision making, ownership, and responsibility and thus increased participation in PMTCT of HIV. CONCLUSIONS The CMOs developed in this review give contextual advice on how one might improve ANC services to increase MI and help reduce MTCT of HIV. We propose that MI in ANC works best where couples are monogamous and trusting, where ANC spaces actively promote being a 'male friendly space' and where there are high levels of community education programs around MTCT.
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Affiliation(s)
- Jacinta Clark
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University and Western Health Partnership, Burwood, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Simangaliso Nyoni
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paul R. Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Bekele YA, Tafere TE, Emiru AA, Netsere HB. Determinants of antenatal care dropout among mothers who gave birth in the last six months in BAHIR Dar ZURIA WOREDA community; mixed designs. BMC Health Serv Res 2020; 20:846. [PMID: 32912256 PMCID: PMC7488008 DOI: 10.1186/s12913-020-05674-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Antenatal care is the care provides for a pregnant mother to improve the health of the mother and her baby. But in the World including Ethiopia still, mothers do not receive the required number of antenatal care visits. Therefore, the main aim of this study was to identify determinants of Antenatal care visit dropout in Bahir Dar Zuria Woreda North West Ethiopia. Methods The study was community-based unmatched case-control study that employed both quantitative and qualitative data. For the quantitative part, 134 cases and 266 controls (total 400) women who gave births in the last six months prior to the study in Bahir Dar Zuria Woreda were enrolled. Data were collected through face to face interviews from March 1 to 30, 2018 using a structured questionnaire. Bivariate and multivariate analysis was used. 95% confidence interval and P-value was used to measure the level of significance. For the qualitative part, six FGDs were conducted and open code software was used for the analysis of the data. The finding was narrated by triangulating with the quantitative findings. Result Being far distance (AOR 7.26; 95% CI 4.23, 23.01), not having a companion (AOR 3.49; 95% CI; 2.39, 8.44), lack of knowledge (AOR 2.57; 95% CI; 1.25, 5.28), poor wealth index (AOR; 3.36, 95% CI 1.71, 6.62) and not developing a danger sign (AOR 2.18; 95% CI 2.28, 7.64) were predictors of ANC dropout. In addition to this, in the qualitative finding, the socio-culture of the community, attitudes, experience, and perception of the existing services and service provisions were also determinants of ANC drop out. Conclusion Socio-cultural, economic, accessibility, and individual factors were determinants of ANC visit drop out. In addition, the behavior of the professional, the mother understands of the existing services, and their perception about ANC influenced ANC dropout.
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Affiliation(s)
- Yibeltal Alemu Bekele
- Department of Reproductive Health and Population Studies, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Tadesse Ejigu Tafere
- Department of Reproductive Health and Population Studies, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amanu Aragaw Emiru
- Department of Reproductive Health and Population Studies, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Henok Biresaw Netsere
- Department of Nursing, School of Health science, Bahir Dar University, Bahir Dar, Ethiopia
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Psaros C, Smit JA, Mosery N, Bennett K, Coleman JN, Bangsberg DR, Safren SA. PMTCT Adherence in Pregnant South African Women: The Role of Depression, Social Support, Stigma, and Structural Barriers to Care. Ann Behav Med 2020; 54:626-636. [PMID: 32128556 PMCID: PMC7459185 DOI: 10.1093/abm/kaaa005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Depression is a robust predictor of nonadherence to antiretroviral (ARV) therapy, which is essential to prevention of mother-to-child transmission (PMTCT). Women in resource-limited settings face additional barriers to PMTCT adherence. Although structural barriers may be minimized by social support, depression and stigma may impede access to this support. PURPOSE To better understand modifiable factors that contribute to PMTCT adherence and inform intervention development. METHODS We tested an ARV adherence model using data from 200 pregnant women enrolled in PMTCT (median age 28), who completed a third-trimester interview. Adherence scores were created using principal components analysis based on four questions assessing 30-day adherence. We used path analysis to assess (i) depression and stigma as predictors of social support and then (ii) the combined associations of depression, stigma, social support, and structural barriers with adherence. RESULTS Elevated depressive symptoms were directly associated with significantly lower adherence (est = -8.60, 95% confidence interval [-15.02, -2.18], p < .01). Individuals with increased stigma and depression were significantly less likely to utilize social support (p < .01, for both), and higher social support was associated with increased adherence (est = 7.42, 95% confidence interval [2.29, 12.58], p < .01). Structural barriers, defined by income (p = .55) and time spent traveling to clinic (p = .31), did not predict adherence. CONCLUSIONS Depression and social support may play an important role in adherence to PMTCT care. Pregnant women living with HIV with elevated depressive symptoms and high levels of stigma may suffer from low social support. In PMTCT programs, maximizing adherence may require effective identification and treatment of depression and stigma, as well as enhancing social support.
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Affiliation(s)
- Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Jennifer A Smit
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
- School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Nzwakie Mosery
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Kara Bennett
- Bennett Statistical Consulting, Inc., Ballston Lake, NY
| | - Jessica N Coleman
- Department of Psychology and Neuroscience, Duke University, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - David R Bangsberg
- School of Public Health, Oregon Health Sciences University–Portland State University, Portland, OR
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL
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Sack DE, Frisby MB, Diemer MA, De Schacht C, Graves E, Kipp AM, Emílio A, Matino A, Barreto E, Van Rompaey S, Wallston KA, Audet CM. Interpersonal reactivity index adaptation among expectant seroconcordant couples with HIV in Zambézia Province, Mozambique. BMC Psychol 2020; 8:90. [PMID: 32859272 PMCID: PMC7456002 DOI: 10.1186/s40359-020-00442-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/15/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The ability to understand another's emotions and act appropriately, empathy, is an important mediator of relationship function and health intervention fidelity. We adapted the Interpersonal Reactivity Index (IRI) - an empathy scale - among seroconcordant expectant couples with HIV in the Homens para Saúde Mais (HoPS+) trial - a cluster randomized controlled trial assessing couple-based versus individual treatment on viral suppression - in Zambézia Province, Mozambique. METHODS Using baseline data from 1332 HoPS+ trial participants (666 couples), an exploratory factor analysis assessed culturally relevant questions from the IRI. Because empathy is interdependent among couples, we validated the results of the exploratory factor analysis using a dyadic confirmatory factor analysis (CFA) with dyadic measurement invariance testing. Finally, we assessed the relationship between scores on our final scale and basic demographic characteristics (sex, age, education, and depression) using t-tests. RESULTS We found two subscales: 1) a seven-item cognitive empathy subscale (Cronbach's alpha 0.78) and 2) a six-item affective empathy subscale (Cronbach's alpha 0.73). The dyadic CFA found acceptable model fit and metric invariance across partners (Comparative Fit Index (CFI) = 0.914, Tucker Lewis Index = 0.904, Root Mean Squared Error of Approximation = 0.056, ΔCFI = 0.011). We observed higher cognitive (p: 0.012) and affective (p: 0.049) empathy among males and higher cognitive (p: 0.031) and affective (p: 0.030) empathy among younger participants. More educated participants had higher affective empathy (p: 0.017) and depressed participants had higher cognitive empathy (p: < 0.001). This two-subscale, 13-item version of the IRI measures cognitive and affective empathy in HoPS+ trial participants and adults while accounting for the interdependent nature of empathy within partner dyads. CONCLUSIONS This scale will allow us to assess the interplay between empathy and other psychometric constructs (stigma, social support, etc.) in the HoPS+ trial and how each relates to retention in HIV, adherence to treatment, and prevention of maternal to child HIV transmission. Furthermore, this scale can be adapted for other sub-Saharan African populations, which will allow researchers to better assess HIV-related intervention efficacy. TRIAL REGISTRATION This study is within the context of the HoPS+ trial, registered at ClinicalTrials.gov as number NCT03149237 . Registered May 11, 2017.
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Affiliation(s)
- Daniel E Sack
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.
| | | | | | | | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | | | | | | | | | | | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
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Kisigo GA, Ngocho JS, Knettel BA, Oshosen M, Mmbaga BT, Watt MH. "At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania. PLoS One 2020; 15:e0238232. [PMID: 32853233 PMCID: PMC7451655 DOI: 10.1371/journal.pone.0238232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.
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Affiliation(s)
- Godfrey A. Kisigo
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - James S. Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Brandon A. Knettel
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Martha Oshosen
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- The University of Cape Town, Cape Town, South Africa
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Melissa H. Watt
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Iliyasu Z, Galadanci HS, Muhammad B, Yadudu FZ, Kwaku AA, Salihu HM, Aliyu MH. Correlates of HIV-Positive Fathers' Involvement in Prevention of Mother-to-child Transmission Programs in Northern Nigeria. Curr HIV Res 2020; 18:443-457. [PMID: 32778029 DOI: 10.2174/1570162x18666200810133347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The involvement of men in prevention of mother-to-child HIV transmission (PMTCT) programs could accelerate the elimination of vertical transmission. Yet, little research has focused on HIV-positive male partners. This study determined the predictors of male partners' PMTCT knowledge and involvement in a tertiary hospital in northern Nigeria. METHODS A clinic-based sample of 401 HIV-positive male partners of women who delivered within 12 months prior were interviewed using structured questionnaires. PMTCT knowledge and involvement scores were computed. Adjusted odd ratios (AOR) for predictors were derived from multivariate logistic regression models. RESULTS The proportion of respondents with adequate PMTCT knowledge was 40.9%. Less than half (43.6%) of the respondents participated in PMTCT, with median involvement score of 2.00 (interquartile range, IQR = 0, 5.0). One quarter of respondents (25.7%, n =103) reported >1 sex partners, 10.5% consistently used condoms, and 20.7% had disclosed to all partners. Fathers' involvement in PMTCT was predicted by paternal education (AOR = 0.30; 95% Confidence Interval (CI): 0.12-0.77, no formal vs. post-secondary), HIV-positive child (AOR = 3.85; 95%CI: 1.41-10.54, yes vs. no), treatment duration (AOR = 4.17; 95%CI: 1.67-10.41, ≤1 vs. ≥10 years), disclosure to partner(s) (AOR = 1.21; 95%CI: 1.15-3.52, 'disclosed to all' vs. 'not disclosed'), condom use (AOR = 5.81; 95%CI: 3.07-11.0, always vs. never), and PMTCT knowledge (AOR = 0.62; 95%CI: 0.31-0.92, inadequate versus adequate). CONCLUSION The involvement of fathers in HIV PMTCT programs was low and predicted by paternal education, HIV-positive child, duration of antiretroviral treatment, disclosure to partner, consistent condom use, and level of PMTCT knowledge. Our findings will inform the development of policies to increase male partner involvement in PMTCT in Nigeria.
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Affiliation(s)
- Zubairu Iliyasu
- Epidemiology & Biostatistics Division, Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | | | - Bashir Muhammad
- Epidemiology & Biostatistics Division, Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Fatima Z Yadudu
- School of Medicine, University of Kentucky, Lexington, KY, United States
| | - Aminatu A Kwaku
- Epidemiology & Biostatistics Division, Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Muktar H Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health,Vanderbilt University Medical Center, Tennessee, United States
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Dube A, Renju J, Wamoyi J, Hassan F, Seeley J, Chimukuche RS, Songo J, Kalua T, Crampin A, Moshabela M, Wringe A. Consequences of male partner engagement policies on HIV care-seeking in three African countries: Findings from the SHAPE UTT study. Glob Public Health 2020; 16:216-226. [PMID: 32780669 PMCID: PMC7612866 DOI: 10.1080/17441692.2020.1805788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We explored how strategies to promote male partner engagement influenced HIV care-seeking among men and women living with HIV. In-depth interviews were conducted with 25 health workers, 66 female service users and 10 male partners in Ifakara (Tanzania), Karonga (Malawi) and uMkhanyakude (South Africa) to elicit experiences of offering, providing or receiving HIV care in the context of antenatal care. Data were coded inductively and analysed thematically. Participants reported benefits of couple testing during antenatal care, including facilitated HIV status disclosure and mutual support for HIV care-seeking. However, unintended consequences included women attending without partners, being refused or delayed access to antenatal services. Some women were required to obtain letters from village leaders to justify the absence of their partners, again to delaying or disrupting care-seeking. When partners attended antenatal care, consultations were reportedly more likely to focus on HIV testing, and less on antenatal or neonatal care. Strategies to increase men's attendance at HIV clinics with their partners can promote mutual support within couples for HIV care engagement, but may risk undermining engagement in pregnancy and HIV care for some women if over-stringently applied. Efforts are needed to address the underlying pervasive stigma associated with HIV care, both alone and as a couple.
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Affiliation(s)
- Albert Dube
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Jenny Renju
- Department of population health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Joyce Wamoyi
- Mwanza Intervention Trials Unit, Mwanza, United Republic of Tanzania
| | - Farida Hassan
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Janet Seeley
- Department of population health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - John Songo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Thokozani Kalua
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.,Department of population health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mosa Moshabela
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,University of Kwa-Zulu Natal, Durban, South Africa
| | - Alison Wringe
- Department of population health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Chi BH, Mbori‐Ngacha D, Essajee S, Mofenson LM, Tsiouris F, Mahy M, Luo C. Accelerating progress towards the elimination of mother-to-child transmission of HIV: a narrative review. J Int AIDS Soc 2020; 23:e25571. [PMID: 32820609 PMCID: PMC7440973 DOI: 10.1002/jia2.25571] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Findings from biomedical, behavioural and implementation studies provide a rich foundation to guide programmatic efforts for the prevention of mother-to-child HIV transmission (PMTCT). METHODS We summarized the current evidence base to support policy makers, programme managers, funding agencies and other stakeholders in designing and optimizing PMTCT programmes. We searched the scientific literature for PMTCT interventions in the era of universal antiretroviral therapy for pregnant and breastfeeding women (i.e. 2013 onward). Where evidence was sparse, relevant studies from the general HIV treatment literature or from prior eras of PMTCT programme implementation were also considered. Studies were organized into six categories: HIV prevention services for women, timely access to HIV testing, timely access to ART, programme retention and adherence support, timely engagement in antenatal care and services for infants at highest risk of HIV acquisition. These were mapped to specific missed opportunities identified by the UNAIDS Spectrum model and embedded in UNICEF operational guidance to optimize PMTCT services. RESULTS AND DISCUSSION From May to November 2019, we identified numerous promising, evidence-based strategies that, properly tailored and adopted, could contribute to population reductions in vertical HIV transmission. These spanned the HIV and maternal and child health literature, emphasizing the importance of continued alignment and integration of services. We observed overlap between several intervention domains, suggesting potential for synergies and increased downstream impact. Common themes included integration of facility-based healthcare; decentralization of health services from facilities to communities; and engagement of partners, peers and lay workers for social support. Approaches to ensure early HIV diagnosis and treatment prior to pregnancy would strengthen care across the maternal lifespan and should be promoted in the context of PMTCT. CONCLUSIONS A wide range of effective strategies exist to improve PMTCT access, uptake and retention. Programmes should carefully consider, prioritize and plan those that are most appropriate for the local setting and best address existing gaps in PMTCT health services.
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Affiliation(s)
- Benjamin H Chi
- University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | | | | | - Mary Mahy
- Joint United Nations Programme on HIV/AIDS (UNAIDS)GenevaSwitzerland
| | - Chewe Luo
- United Nations Children’s Fund (UNICEF)New YorkNYUSA
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Wall KM, Inambao M, Kilembe W, Karita E, Chomba E, Vwalika B, Mulenga J, Parker R, Sharkey T, Tichacek A, Hunter E, Yohnka R, Streeb G, Corso PS, Allen S. Cost-effectiveness of couples' voluntary HIV counselling and testing in six African countries: a modelling study guided by an HIV prevention cascade framework. J Int AIDS Soc 2020; 23 Suppl 3:e25522. [PMID: 32602618 PMCID: PMC7325504 DOI: 10.1002/jia2.25522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/17/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Couples' voluntary HIV counselling and testing (CVCT) is a high-impact HIV prevention intervention in Rwanda and Zambia. Our objective was to model the cost-per-HIV infection averted by CVCT in six African countries guided by an HIV prevention cascade framework. The HIV prevention cascade as yet to be applied to evaluating CVCT effectiveness or cost-effectiveness. METHODS We defined a priority population for CVCT in Africa as heterosexual adults in stable couples. Based on our previous experience nationalizing CVCT in Rwanda and scaling-up CVCT in 73 clinics in Zambia, we estimated HIV prevention cascade domains of motivation for use, access and effectiveness of CVCT as model parameters. Costs-per-couple tested were also estimated based on our previous studies. We used these parameters as well as country-specific inputs to model the impact of CVCT over a five-year time horizon in a previously developed and tested deterministic compartmental model. We consider six countries across Africa with varied HIV epidemics (South Africa, Zimbabwe, Kenya, Tanzania, Ivory Coast and Sierra Leone). Outcomes of interest were the proportion of HIV infections averted by CVCT, nationwide CVCT implementation costs and costs-per-HIV infection averted by CVCT. We applied 3%/year discounting to costs and outcomes. Univariate and Monte Carlo multivariate sensitivity analyses were conducted. RESULTS We estimated that CVCT could avert between 54% (Sierra Leone) and 62% (South Africa) of adult HIV infections. Average costs-per-HIV infection averted were lowest in Zimbabwe ($550) and highest in South Africa ($1272). Nationwide implementations would cost between 7% (Kenya) and 21% (Ivory Coast) of a country's President's Emergency Plan for AIDS Relief (PEPFAR) budget over five years. In sensitivity analyses, model outputs were most sensitive to estimates of cost-per-couple tested; the proportion of adults in heterosexual couples and HIV prevention cascade domains of CVCT motivation and access. CONCLUSIONS Our model indicates that nationalized CVCT could prevent over half of adult HIV infections for 7% to 21% of the modelled countries' five-year PEPFAR budgets. While other studies have indicated that CVCT motivation is high given locally relevant promotional and educational efforts, without required indicators, targets and dedicated budgets, access remains low.
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Affiliation(s)
- Kristin M Wall
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of EpidemiologyRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Mubiana Inambao
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Obstetrics and GynecologyNdola Central HospitalNdolaZambia
| | - William Kilembe
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Etienne Karita
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | | | - Bellington Vwalika
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Obstetrics and GynecologySchool of MedicineUniversity of ZambiaLusakaZambia
| | - Joseph Mulenga
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Rachel Parker
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Tyronza Sharkey
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Eric Hunter
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Pathology & Laboratory MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
- Emory Vaccine CenterYerkes National Primate Research CenterEmory UniversityAtlantaGAUSA
| | - Robert Yohnka
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Gordon Streeb
- Departments of Economics and Political ScienceEmory UniversityAtlantaGAUSA
| | | | - Susan Allen
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
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Hildon ZJL, Escorcio-Ymayo M, Zulliger R, Arias de Aramburú R, Lewicky N, Harig H, Chidassicua JB, Underwood C, Pinto L, Figueroa ME. "We have this, with my husband, we live in harmony": exploring the gendered decision-making matrix for malaria prevention and treatment in Nampula Province, Mozambique. Malar J 2020; 19:133. [PMID: 32228613 PMCID: PMC7106709 DOI: 10.1186/s12936-020-03198-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Conceptualizing gender dynamics and ways of bridging entrenched gender roles will contribute to better health promotion, policy and planning. Such processes are explored in relation to malaria in Mozambique. Methods A multi-method, qualitative study using focus group discussions (FGDs) and in-depth interviews (IDIs) explored the perspectives of community members, leaders and stakeholders on malaria. The study was conducted in Nampula Province, in an intervention district for the Tchova Tchova Stop Malaria (TTSM) gender-sensitive community dialogues, and in a non-intervention district. Results Participants (n = 106) took part in six FGDs and five IDIs in each district. Those exposed to TTSM commonly stated that the programme influenced more equalitarian gender roles, attitudes and uptake of protective malaria-related practices. These positive changes occurred within the context of an observed, gendered decision-making matrix, which aligns inward- or outward-facing decisions with malaria prevention or treatment. Decisions more dependent on male or elder sanctioning at community level are outward-facing decisions, while decisions falling within women’s domain at household level are inward-facing decisions. Related to prevention, using bed nets was largely an inward-facing prevention decision for women, who were generally tasked with hanging, washing and making nets usable. Net purchase and appropriation for malaria prevention (rather than for instance for fishing) was men’s prerogative. Regular net use was associated with sleeping together more regularly, bringing couples closer. Attending antenatal care to access intermittent preventive treatment during pregnancy was often an outward-facing prevention decision, under the purview of older, influential women and ultimately needing sanctioning by men. With respect to seeking care for malaria symptoms, women typically sought help from traditional healers first. This inward-facing treatment decision was within their control, in contrast to the frequently transport-dependent, outward-facing decision to attend a health facility. Sharing decisions was described as a feature of a “harmonious household,” something that was said to be encouraged by the TTSM intervention and that was both lived and aspirational. Conclusions TTSM community dialogues helped communication on both interpersonal (couple) and community levels, ultimately encouraging malaria-related behaviours. Leveraging ways of bringing men and women together to share decision making will improve malaria intervention success.
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Affiliation(s)
- Zoe Jane-Lara Hildon
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA. .,Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Level 09-03J, Singapore, 117549, Singapore.
| | - Maria Escorcio-Ymayo
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Rose Zulliger
- U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Rosario Arias de Aramburú
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Nan Lewicky
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Hunter Harig
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Jose Braz Chidassicua
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Maputo, Mozambique
| | - Carol Underwood
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Liliana Pinto
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Maputo, Mozambique
| | - Maria Elena Figueroa
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
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Hannaford A, Lim J, Moll AP, Khoza B, Shenoi SV. 'PrEP should be for men only': Young heterosexual men's views on PrEP in rural South Africa. Glob Public Health 2020; 15:1337-1348. [PMID: 32207661 DOI: 10.1080/17441692.2020.1744680] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Gaps persist in HIV testing, treatment, and prevention services for men, leading to higher attributable mortality compared to women. We sought to characterise HIV prevention knowledge, risk behaviours, and interest in pre-exposure prophylaxis (PrEP) among young men in rural South Africa. METHODS We conducted interviews with HIV-negative heterosexual men which were thematically analysed to identify key themes. RESULTS Among 31 participants, median age was 26 (IQR23-31), 77% were unemployed, 52% reported previous STI, 84% reported casual sexual partners. Men acknowledged inconsistent condom use with multiple partners, reporting high-risk sexual behaviour despite recognised risk. Mistrust between partners was common. Respondents reported willingness to take PrEP to protect themselves and their partner, though anticipated stigma and structural barriers. Men worried that if their female partner had PrEP, she would become sexually active with others. CONCLUSIONS In rural South Africa, young heterosexual men acknowledged high HIV-risk behaviour, expressed concern about acquiring HIV, and recognised the value of PrEP. Men were often not supportive of their female partners taking PrEP. Implementing HIV prevention services needs to incorporate young men's perspectives and may require gender-specific interventions, including addressing stigma, differentiated service delivery models such as community-based services or adapting facility services to target men.
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Affiliation(s)
| | - Jamie Lim
- Boston Medical Center, Boston.,Boston Children's Hospital, Boston
| | - Anthony P Moll
- Church of Scotland Hospital, Tugela Ferry, South Africa.,Philanjalo NGO, Tugela Ferry, South Africa
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Mabachi NM, Brown M, Sandbulte M, Wexler C, Goggin K, Maloba M, Finocchario-Kessler S. Using a Social Support Framework to Understand How HIV Positive Kenyan Men Engage in PMTCT/EID Care: Qualitative Insights From Male Partners. AIDS Behav 2020; 24:18-28. [PMID: 30877581 PMCID: PMC6745277 DOI: 10.1007/s10461-019-02451-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Greater male partner involvement in Prevention of Mother to Child Transmission (PMTCT) and Early Infant Diagnosis (EID) is associated with improved outcomes. Perceived low social support for the mother can negatively impact the uptake of PMTCT/EID services. Most research relies on women's reports of the types and quality of male partner support received versus what is desired. This qualitative study examines Kenyan male partners' reported social support provision pre- and post-partum from their own perspective. The study was embedded within intervention development studies in Kenya designed to develop and pilot a PMTCT module of a web based system to improve EID. Focus groups were conducted with male partners of pregnant women with HIV and elicited feedback on male partner involvement in maternal and child care and factors affecting participation. Interviews were analyzed within a theoretical social support framework. Participants described providing tangible support (financial resources), informational support (appointment reminders) and emotional support (stress alleviation in the face of HIV-related adversity). African conceptualizations of masculinity and gender norms influenced the types of support provided. Challenges included economic hardship; insufficient social support from providers, peers and bosses; and HIV stigma. Collaboration among providers, mothers and partners; a community-based social support system; and recasting notions of traditional masculinity were identified as ways to foster male partner support.
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Affiliation(s)
- Natabhona M Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Matthew Sandbulte
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Kathy Goggin
- Children's Mercy Kansas City, Health Services and Outcomes Research, Kansas City, MO, USA
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
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Pollahan A, Thinkhamrop J, Kongwattanakul K, Chaiyarach S, Sutthasri N, Lao-Unka K. Rate of Couple HIV Testing in a Prenatal Care Clinic and Factors Associated with Refusal of Testing Among Male Partners. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:369-375. [PMID: 32021479 PMCID: PMC6942528 DOI: 10.2147/hiv.s232191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022]
Abstract
Objective To determine the rate of HIV testing in couples during pregnancy and the reasons and risk factors related to male partners refusing to be tested. Materials and methods This was a cross-sectional study conducted in pregnant women undergoing prenatal care after receiving information about HIV testing on their first visit. After 20 weeks of gestation, they were approached to participate in the study, which consisted of an interview and examination of their medical records. Data collection included the women’s socioeconomic status, obstetric condition and serological test results together with their partner information. If relevant, the partner’s reasons for refusing to undergo HIV testing. Results A total of 400 pregnant women were recruited between February and August 2018, 150 (37.5%) of whose male partners underwent HIV testing. There were five couples in which one or both members were found to be positive for HIV: 1 seroconcordant couple, 1 serodiscordant couple in which the pregnant woman was positive, and 3 serodiscordant couples in which the male partners were positive. The most common reason for male partners refusing to take the test was their already having been tested once before. The women having had other sexual partners prior to their current partners was a significant risk factor for the partners refusing to be tested. Conclusion There was a low rate of couple HIV testing and a substantial portion of discordant infection among positive couples. Routine couples counseling and testing should be encouraged to reduce the vertical transmission and the number of new cases of HIV infection.
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Affiliation(s)
- Achara Pollahan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Jadsada Thinkhamrop
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kiattisak Kongwattanakul
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sukanya Chaiyarach
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Nutwara Sutthasri
- Nursing Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kesorn Lao-Unka
- Nursing Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Triulzi I, Palla I, Ciccacci F, Orlando S, Palombi L, Turchetti G. The effectiveness of interventions to involve men living with HIV positive pregnant women in low-income countries: a systematic review of the literature. BMC Health Serv Res 2019; 19:943. [PMID: 31815620 PMCID: PMC6902537 DOI: 10.1186/s12913-019-4689-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Male involvement (MI) along the continuum of HIV healthcare services has been promoted as a critical intervention in low-income countries and represents one of the reasons for dropout and low retention of women along the cascade of care. The present review aims to identify interventions adopted to improve MI across Antenatal Clinics (ANCs). METHODS For this systematic review, we searched electronic databases, including Scopus, PubMed, Web of Science (from 2008 to 2018) in English language. We included all interventions explicitly aimed at involving partners in pregnant women's HIV continuum of care and we excluded studies performed in developed countries, not involving pregnant women. We followed the PRISMA checklist. RESULTS We identified a total of 1694 records and excluded 1651 after duplicates were removed and abstract eligibility assessments were performed. Forty-three full-text articles were screened, but only 12 studies were included. Recurrent intermediate outcomes were antenatal partner attendance rate and male HIV testing. We subdivided articles according to the type of intervention: single intervention (7) and multiple interventions (5). Among single interventions, two studies evaluated the use of an invitation letter sent via women to encourage male attendance to the ANC. Four Randomized Controlled Trials (RCTs) compared the invitation card (standard of care, SC) to word of mouth, information letter, home visit and invitation card plus partner tracing. The partner attendance rate was lower in SC than in the intervention arm in three RCTs: information letter (14.2% vs 16.2%), home-visit (39% vs 87%) and invitation card plus partner tracing (52% vs 74%). Home visit strategies seemed the most effective. One study evaluated words of encouragement adopted to trigger women to invite their partners. Among multiple interventions, the most effective strategies in terms of male attendance included health promotion through education and healthcare worker development. These interventions were more likely to be effective in promoting MI than single interventions. CONCLUSIONS From the review emerges the importance of male involvement in HIV cascade for pregnant women in countries with a significant HIV incidence and the need to define more precise indicators for measuring MI.
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Affiliation(s)
- Isotta Triulzi
- Institute of Management, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Fausto Ciccacci
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
- International University of Health and Medical Science, UniCamillus, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
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Dowden J, Mushamiri I, McFeely E, Apat D, Sacks J, Ben Amor Y. The impact of "male clinics" on health-seeking behaviors of adult men in rural Kenya. PLoS One 2019; 14:e0224749. [PMID: 31751377 PMCID: PMC6872147 DOI: 10.1371/journal.pone.0224749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In most parts of the world, men access health services less frequently than women, and this trend is unrelated to differences in need for services. While male involvement in healthcare as partners or fathers has been extensively studied, less is known about the health-seeking behavior of men as clients themselves. This interventional research study aimed to determine how the introduction of male-friendly clinics impacted male care-seeking behavior and to describe the reasons for accessing services among men in rural Kenya. METHODS AND FINDINGS We questioned men to assess utilization and perceptions of existing health clinics, then designed and evaluated a "male clinics" intervention where dedicated male health workers were hired for one year to offer routine, free services exclusively to men within existing healthcare facilities. Results were compared between data from Male Clinics in specific health facilities, the same facilities concurrently, nearby control facilities concurrently, and intervention facilities historically. Costs of services, distance to facilities, and quality of care were the main barriers to healthcare access reported. The number of total visits was significantly higher than control groups (p<0·0001). In the intervention group, 18·6% of visits were for a checkup compared to almost none in control groups. The most common diagnoses overall were upper respiratory tract infections, malaria and injury. A major limitation of this study is the non-comparability in information captured using the Male Clinic registers compared to control registers. CONCLUSIONS Costs and quality of services deter men from seeking healthcare. The introduction of male-friendly health services could encourage men to seek preventive care and increase service uptake.
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Affiliation(s)
- Justine Dowden
- Center for Sustainable Development, Earth Institute, Columbia University, New York, NY, United States of America
| | - Ivy Mushamiri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Eric McFeely
- Center for Sustainable Development, Earth Institute, Columbia University, New York, NY, United States of America
| | - Donald Apat
- Columbia Global Centers East and Southern Africa, Nairobi, Kenya
| | - Jilian Sacks
- Center for Sustainable Development, Earth Institute, Columbia University, New York, NY, United States of America
| | - Yanis Ben Amor
- Center for Sustainable Development, Earth Institute, Columbia University, New York, NY, United States of America
- * E-mail:
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Policymaker, health provider and community perspectives on male involvement during pregnancy in southern Mozambique: a qualitative study. BMC Pregnancy Childbirth 2019; 19:384. [PMID: 31660898 PMCID: PMC6819364 DOI: 10.1186/s12884-019-2530-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 09/23/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Increasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. Intervention studies aimed at improving maternal health mostly target mothers hereby ignoring the crucial role their partners play in their ability to access antenatal care (ANC) and to prevent and treat infectious diseases like HIV and malaria. Very little is known about the current level of male involvement and barriers at different levels. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men's involvement in maternal health in southern Mozambique. METHODS Ten key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in programmes addressing maternal health, followed by 11 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis. RESULTS Results show a lack of strategy and coherence at policy level to stimulate male involvement in maternal health programmes. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity. CONCLUSION A clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and providers should be trained to involve men in ANC.
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Ha JH, Van Lith LM, Mallalieu EC, Chidassicua J, Pinho MD, Devos P, Wirtz AL. Gendered relationship between HIV stigma and HIV testing among men and women in Mozambique: a cross-sectional study to inform a stigma reduction and male-targeted HIV testing intervention. BMJ Open 2019; 9:e029748. [PMID: 31594877 PMCID: PMC6797434 DOI: 10.1136/bmjopen-2019-029748] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Increasing and sustaining engagement in HIV care for people living with HIV are critical to both individual therapeutic benefit and epidemic control. Men are less likely to test for HIV compared with women in sub-Saharan African countries, and ultimately have delayed entry to HIV care. Stigma is known to impede such engagement, placing an importance on understanding and addressing stigma to improve HIV testing and care outcomes. This study aimed to assess the gendered differences in the relationship between stigma and HIV testing. DESIGN AND SETTING A cross-sectional, household probability survey was implemented between November and December 2016 in the Sofala province of Mozambique. PARTICIPANTS Data were restricted to men and women participants who reported no prior diagnosis of HIV infection (N=2731). MEASURES Measures of sociodemographic characteristics, stigma and past exposure to HIV interventions were included in gender-stratified logistic regression models to estimate the relationship between stigma and recent testing for HIV, as well as to identify other relevant correlates. RESULTS Significantly fewer men (38.3%) than women (47.6%; p<0.001) had recently tested for HIV. Men who reported previous engagement in community group discussions about HIV had an increased odds of testing in the past 12 months compared to those who had not participated (adjusted OR (aOR)=1.92; 95% CI 1.51 to 2.44). Concerns about stigma were not a commonly reported barrier to HIV testing; however, men who expressed anticipated individual HIV stigma had a 35% lower odds of recent HIV testing (aOR=0.65; 95% CI 0.44 to 0.96). This association was not observed among women. CONCLUSIONS Men have lower uptake of HIV testing in Mozambique when compared to women. Even amidst the beneficial effects of HIV messaging, individual stigma is negatively associated with recent HIV testing among men. Intervention efforts that target the unique challenges and needs of men are essential in promoting men's engagement into the HIV care continuum in sub-Saharan Africa.
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Affiliation(s)
- Judy H Ha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lynn M Van Lith
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Elizabeth C Mallalieu
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Jose Chidassicua
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Maria Dirce Pinho
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Patrick Devos
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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