HIV testing of male partners of pregnant women in Porto Alegre, Brazil: A potential strategy for reduction of HIV seroconversion during pregnancy

Abstract

Pregnant women have a significantly higher risk of HIV acquisition during gestation than their non-pregnant counterparts due to behavioral and biological factors. Acute seroconversion during gestation results in increased HIV mother-to-child transmission rates and has been identified as a major public health challenge. In order to address potential HIV seroconversion in our pregnant patients, we conducted a prospective cohort study to evaluate the acceptability of offering HIV testing to sexual partners of HIV-negative pregnant women receiving antenatal care at 2 hospitals in Porto Alegre, Brazil. Over a 14 month study period, HIV-negative pregnant women at two hospital-based clinic sites were encouraged to bring their stable sexual partner for HIV voluntary counseling and testing during prenatal care. Women were re-interviewed following delivery to measure success of the intervention. Of the 1223 HIV-negative pregnant women enrolled in the study, 663 (54%) of their male sexual partners received HIV testing during antenatal care and 4 (0.6%) were diagnosed with HIV infection. Six hundred and forty five women were interviewed at the time of delivery, with 620 (97%) confirming that HIV testing was suggested to their partner. The most common reason provided by women as to why partners did not come for testing was work (69%) and lack of perceived risk (14%). Independent predictors of successful partner testing included being white (OR 1.59, 95% CI 1.18–2.12), married (OR 1.78, 95% CI 1.08–2.94), having an older age of sexual debut (OR 0.94, 95% CI 0.9–0.98), and being recruited at Hospital Conceiçao (OR 2.1, 95% CI 1.52–2.88). We conclude that HIV partner testing during prenatal care is acceptable, rendering this intervention attractive to public health programs targeting prevention of sexually transmitted infections.

Improving male involvement in antenatal care in low and middle-income countries to prevent mother to child transmission of HIV: A realist review

“…Table 2 identifies basic characteristics of study setting and type of the included studies. Of the 44 articles included, 24 were qualitative studies [ 13 , 14 , 18 – 23 , 25 , 27 , 28 , 39 – 51 ], 10 were cross sectional studies [ 26 , 51 – 59 ], 3 were cohort studies [ 24 , 60 , 61 ], 3 were systematic reviews [ 12 , 16 , 17 ], 3 were randomised control trials [ 62 – 64 ], and 1 used mixed methods [ 15 ].…”

“…Studies were set in a number of countries including (in order of frequency) South Africa [ 12 , 17 , 20 , 40 , 41 , 51 , 57 , 62 ], Kenya [ 12 , 17 , 50 , 53 , 58 , 61 , 63 ], Uganda [ 12 , 14 , 17 , 42 , 43 , 52 , 54 ], Malawi [ 12 , 17 , 21 , 23 , 24 , 27 ], Tanzania [ 12 , 13 , 17 , 44 , 56 ], Cameroon [ 12 , 15 , 17 , 64 ], Zambia [ 12 , 19 , 39 ], India [ 15 , 17 , 64 ], Democratic Republic of Congo [ 12 , 17 , 49 ], Mozambique [ 26 , 46 , 48 ], Brazil [ 25 , 51 , 60 ], Ethiopia [ 55 , …”

“…Being married increased a couple’s likelihood of participating in CVCT [ 12 , 50 , 60 ], although infidelity was repeatedly mentioned as a barrier to MI in any ANC or subsequent CVCT [ 14 , 15 , 52 ]. If either partner had participated in extramarital sexual relationships, the likelihood they would agree to participate in CVCT as a part of ANC was reduced [ 48 , 50 ].…”

Barriers and facilitators for men to attend prenatal care and obtain HIV voluntary counseling and testing in Brazil

“…[ 21 ] In order to curb the incidence of acute HIV acquisition during pregnancy, health units providing prenatal care associated with Hospital Conceiçao are now encouraged to offer HIV voluntary counseling and testing (VCT) to male partners of HIV negative pregnant women. [ 22 , 23 ] In a study performed at this site in 2011, 54% of male partners attended prenatal care received HIV testing; however, most obtained testing during the last few months of pregnancy. [ 23 ] In the non-study setting, health care providers at the site stated that most male partners do not attend prenatal care.…”

Offering pre-exposure prophylaxis for HIV prevention to pregnant and postpartum women: a clinical approach

“…Partner testing and engagement remain cornerstones of identifying women vulnerable to HIV. Several studies describe partner HIV testing of HIV-negative pregnant women in antenatal clinics and off site [ 59 – 65 ]. The HOPE trial in Kenya found that home-based testing for pregnant women and their partners was cost-effective [ 66 ].…”