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

IntroductionPositive health, dignity, and prevention (PHDP) interventions target people living with HIV and AIDS (PLHIV) to promote well-being and prevent onward transmission. Concern that increased life expectancy and improved well-being would lead to increased risky sexual behaviour and subsequent HIV transmission motivated researchers to test novel strategies to support treatment adherence, encourage safer sex, STI treatment and partner testing, prevention of mother to child transmission, and support uptake of family planning.MethodsWe assessed the number and type of PHDP messages delivered to PLHIV before and after the implementation of an educational intervention for health providers combined with the distribution of visual job aids and monthly technical assistance.ResultsFrom April 21, 2013 to March 20, 2014, we documented 54,731 clinical encounters at three rural health centres in Zambézia province, Mozambique from 9,248 unique patients. The percentage of patients who received all seven PHDP messages during their last three visits was 1.9% pre-intervention vs. 13.6% post- intervention (p=<0.001). Younger patients (25 years vs. 35) and those with a recent HIV diagnosis (two weeks vs. two years) had higher odds of receiving any PHDP message (Odds Ratio [OR]: 1.22 and 2.79, respectively). Patients >59 days late collecting medications were not more likely to receive adherence messages than adherent patients (p=0.17).DiscussionTargeting HIV prevention efforts to PLHIV is an effective HIV prevention approach to eliminate HIV transmission. Despite intensive training and support, PHDP message delivery remained unacceptably low in rural Mozambique. Patients at high risk for treatment abandonment were not more likely to be counselled about adherence and support measures, something that needs to be addressed.ConclusionsWe need to develop novel strategies to motivate health care providers to deliver these messages more consistently to all patients and develop a system that assists counsellors and clinicians to quickly and effectively determine which messages should be delivered.

Objetivo. Identificar a percepção dos gestores de saúde sobre as ações adotadas e os desafios encontrados no enfrentamento de HIV e sífilis em mulheres venezuelanas migrantes no Brasil. Métodos. Este estudo descritivo-exploratório, de abordagem qualitativa, foi realizado de janeiro a março de 2021 nos municípios de Boa Vista (estado de Roraima) e Manaus (estado do Amazonas). As entrevistas em áudio realizadas com os participantes foram transcritas na íntegra. A análise foi pautada na técnica de avaliação de conteúdo temática. Resultados. Foram entrevistados 10 gestores (cinco em Boa Vista e cinco em Manaus). A análise de conteúdo identificou os seguintes eixos e temas: estrutura disponível para diagnóstico e tratamento de aids e sífilis — acesso, vagas para atendimento/fila de espera, formação das equipes de saúde e suporte psicossocial; desafios enfrentados pelas mulheres venezuelanas — idioma, questões de documentação e frequência de alteração de endereço; e estratégias e ações adotadas e expectativas para o enfrentamento de HIV/aids e sífilis no contexto de migração. Conclusões. Apesar das ações de acolhimento das mulheres venezuelanas migrantes — garantido pela universalidade do sistema de saúde brasileiro — aspectos como o idioma e a falta de documentação permanecem como barreiras. Diante da inexistência de planos de ação e planejamento futuro da atenção a mulheres migrantes portadoras de HIV ou sífilis nos municípios, é importante desenvolver políticas públicas com o objetivo de minimizar as dificuldades enfrentadas por essa população.

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