Male Partner Participation in Antenatal Clinic Services is Associated With Improved HIV-Free Survival Among Infants in Nairobi, Kenya: A Prospective Cohort Study

Abstract

Objective This prospective study investigated the relationship between male antenatal clinics (ANC) involvement and infant HIV-free survival. Methods From 2009-2013, HIV-infected pregnant women were enrolled from six antenatal clinics (ANC) in Nairobi, Kenya and followed with their infants until six weeks postpartum. Male partners were encouraged to attend antenatally through invitation letters. Males who failed to attend had questionnaires sent for self-completion postnatally. Multivariate regression was used to identify correlates of male attendance. The role of male involvement in infant outcomes of HIV infection, mortality and HIV-free survival were examined. Results Among 830 enrolled women, 519 (62.5%) consented to male participation and 136 (26.2%) men attended the ANC. For the 383 (73.8%) women whose partners failed to attend, 63 (16.4%) were surveyed via outreach. In multivariate analysis, male report of prior HIV testing was associated with maternal ANC attendance (aOR=3.7; 95% CI:1.5-8.9, p=0.003). Thirty-five (6.6%) of 501 infants acquired HIV or died by six weeks of life. HIV-free survival was significantly greater among infants born to women with partner attendance (97.7%) than those without (91.3%) (p=0.01). Infants lacking male ANC engagement had an approximately 4-fold higher risk of death or infection compared to those born to women with partner attendance (HR=3.95, 95% CI:1.21-12.89, p=0.023). Adjusting for antiretroviral use, the risk of death or infection remained significantly greater for infants born to mothers without male participation (aHR=3.79, 95% CI:1.15-12.42, p=0.028). Conclusions Male ANC attendance was associated with improved infant HIV-free survival. Promotion of male HIV testing and engagement in ANC/PMTCT services may improve infant outcomes.

Viral Suppression and Retention in Care up to 5 Years After Initiation of Lifelong ART During Pregnancy (Option B+) in Rural Uganda

“…23 Previous studies have demonstrated that male partner involvement is associated with improved uptake of services for the prevention of perinatal transmission 24 and HIV-free infant survival. 25, 26 Our results suggest that facilitated disclosure interventions may help women to maintain long-term treatment and viral suppression, particularly after delivery and the cessation of breastfeeding, when women remain in care for their own health.…”

Perspectives on HIV partner notification, partner HIV self‐testing and partner home‐based HIV testing by pregnant and postpartum women in antenatal settings: a qualitative analysis in Malawi and Zambia

“…Despite advances in HIV prevention of mother‐to‐child transmission (PMTCT) in sub‐Saharan Africa (SSA), pregnant and postpartum women face a high risk of HIV acquisition from infected male partners and subsequent mother‐to‐child transmission . Similarly, many HIV‐infected women have male partners who are also HIV‐infected and do not know their HIV status . Engaging male partners of pregnant and postpartum women in HIV testing can be a first key step towards improved health outcomes for HIV‐positive or HIV‐negative women, their male partners, and their infants, including better uptake of and adherence to antiretroviral treatment and reduced HIV‐related morbidity and mortality .…”

The effect of HIV counselling and testing on HIV acquisition in sub-Saharan Africa: a systematic review

“…Several strategies, such as partner notification and community invitations have been effective for increasing cHCT and could have important implications if brought to scale. [39][40][41] Such efforts would have benefits on reduced HIV incidence and on reaching global HIV targets, including the 90-90-90 goals and elimination of mother-to-child transmission [42][43][44] Assessing the impact of HCT on HIV acquisition is methodologically challenging. First, all assessments of HIV acquisition require large cohorts followed for long periods with low, nondifferential loss to follow-up.…”