male partner involvement in interventions to prevent mother...

Male Partner Involvement in Interventions to Prevent Mother-to-Child Transmission of HIV

Echezona Ezeanolue, MD, MPHProfessor, Public Health and PediatricsDirector, UNLV Global Health Initiative

University of Nevada Las Vegas

Impact of Male Partner Involvement• Several studies have documented increase in uptake of

PMTC interventions when male partners are involved

• Farquhar et al. 2004 (Kenya 2654 participants) – couple counseling increased uptake of nevirapine and formula feeding

• Msuya et al. 2008 (Tanzania 2654 participants) – male partner effect on uptake of HIV perinatal interventions

• Aluisio et al. 2011(Kenya 456 participants) – male antenatal attendance and HIV testing decreased infant HIV infection

• Jones et al. 2013 (South Africa 1611 participants)– male partner involvement reduced infant HIV incidence

Barriers to Male Partner Involvement• Rates of male partners attending at least one ANC visit in SSA

• 1.8 to 32%

• INDIVIDUAL LEVEL• Lack of awareness about HIV• Perception of low personal risk• Disclosure

• COMMUNITY LEVEL• Gender norms that disapprove of male partners engaging in ANC

• HEALTH SYSTEM LEVEL• Poor attitudes of service providers • Timing of antenatal services during work hours

The Healthy Beginning Initiative (HBI)

Prayer Session • Every Sunday in each church• Identify/recruit pregnant women and

husbands

Baby Shower • Edutainment/Reception• Onsite Integrated Testing (HIV, Hepatitis B, Sickle Cell Genotype, Hemoglobin, Malaria, Syphilis)

• Clinic referral

Baby Reception

• Edutainment• Newborn testing• Linkage to Care

Specific Aims

• To determine whether HBI, a congregation-based intervention compared to clinic-based approach will increase:

• HIV testing among pregnant women

• HIV testing among male partners of pregnant women

• Linkage to care among HIV-infected pregnant women

Ezeanolue et al (2013). Implementation Science.

HIV Testing among Pregnant WomenConfirmed HIV testing among pregnant women

Adjusted Odds Ratio for no HIV test

Ezeanolue et al. (2015). The Lancet. Global Health.

Male Partner Involvement

Participation Rate

Confirmed HIV Testing among Male Partners

Adjusted Odds Ratio for No HIV Test

Ezeanolue et al. (2017). AIDS & Behavior

Total Subjects (N) Tested (N) Rate P valueContro l 1201 453 37.71 < 0.01Intervention 1297 1089 84.0

Females Males Participation RateParticipants 2809 2498 88.90%

Challenges During Recruitment

• Skepticism from communities

• We used a “model” site approach and successful implemented the program in one model site

• Concerns about CG not getting the same benefits as IG

• We agreed to offer HIV testing to women in CG at the completion of the study

• Lack of trained research staff with proper knowledge of HIV

• We opted for community-based health advisors

Challenges During Intervention

• Initial view of HBI as a female-focused program

• Emphasis on male partner involvement resulted in womenpresenting their brothers and brother-in-laws as male partner toenroll

• Participants attending other churches in order to receive asecond mama pack

Challenges During Data Collection

• Low participants education required more assistance to completequestionnaires

• Lack of awareness of basic information such as DOB and income

• Population movement during study and significant infant death

• Reliability of phone numbers to clarify data

Current Adaptations

• Integrating screening for perinatal depression

• Newborn Screening Program

• Linkage to care

• Retention in care

• Early Infant Diagnosis

Iheanacho et al. (2015). Social Psychiatry and Psychiatric Epidemiology; Burnham-Marusich et al. (2016). Public Health Genomics; Pharr et al. (2016). Journal of Acquired Immune Deficiency Syndromes

Summary

• Barriers to male partner participation in antenatal care in sub-Saharan Africa include thetiming of antenatal services during work hours and negative health care provider attitudes

• Include gender norms against male participation that are anchored in deep-seatedperceptions that pregnancy is a woman’s affair

• Critically elements of success include the fact that it was conducted in communities wherereligious institutions and their leaders have strong community influence and where nearly90% of the population attends places of worship

Summary

• It proposed integrated testing (hemoglobin, malaria, sickle cell genotype, HIV,hepatitis B, and syphilis) to reduce stigma associated with HIV testing.

• It included the hemoglobin test because men indicated in the formative stages that they wanted this test tofind out how strong they were.

• It engaged the couples publically, with the religious leader inviting all pregnant womenand their partners each Sunday to approach the altar for a prayer, accompanied byinformation about the baby shower program and the importance of antenatal care.

• The program ran baby showers monthly for all participants with the program group playingan educational game and being offered free integrated HIV testing.

• The control group was referred to a local health facility for antenatal care and free HIV testing.At baby receptions held every two to three months, the control groups were offered freeintegrated HIV testing.

Summary• All in all, HIV testing for male partners was convenient, free, and integrated

with other tests that men wanted. Feasible, Acceptable, Sustainable andTransformational

• Such a strategy could work in other settings where influential communityleaders are prepared to lead the design and implementation of innovativeHIV prevention programmes that resonate with community cultural andspiritual values.

• It was provided in a family-centered, culturally adapted, congregation-basedenabling environment that supported men to step forward with their pregnantpartners to learn their HIV status. Framework for Community-BasedParticipatory Research

• Future Adaptations• Community screening for other health conditions e.g. DM; HTN

HealthySunrise Foundation is a non-profit organization with a core mission to improve birth outcomes through enhanced maternal-

child health programs.

https://www.healthysunrise.org/what-we-do/