Official invitation letters to promote male partner attendance and couple voluntary HIV counselling and testing in antenatal care: an implementation study in Mbeya Region, Tanzania

Abstract

BackgroundThe benefits of male partner involvement in antenatal care (ANC) and prevention of mother-to-child transmission of HIV (PMTCT) for maternal and infant health outcomes have been well recognised. However, in many sub-Saharan African settings, male involvement in these services remains low. Previous research has suggested written invitation letters as a way to promote male partner involvement.MethodsIn this implementation study conducted at three study sites in southwest Tanzania, acceptability of written invitation letters for male partners was assessed. Pre-study CVCT rates of 2–19 % had been recorded at the study sites. Pregnant women approaching ANC without a male partner were given an official letter, inviting the partner to attend a joint ANC and couple voluntary counselling and testing (CVCT) session. Partner attendance was recorded at subsequent antenatal visits, and the invitation was repeated if the partner did not attend. Analysis of socio-demographic indices associated with male partner attendance at ANC was also performed.ResultsOut of 318 women who received an invitation letter for their partner, 53.5 % returned with their partners for a joint ANC session; of these, 81 % proceeded to CVCT. Self-reported HIV-positive status at baseline was negatively associated with partner return (p = 0.033). Male attendance varied significantly between the rural and urban study sites (p < 0.001) with rates as high as 76 % at the rural site compared to 31 % at the urban health centre. The majority of women assessed the joint ANC session as a favourable experience, however 7 (75 %) of women in HIV-positive discordant or concordant relationships reported problems during mutual disclosure. Beneficial outcomes reported one month after the session included improved client- provider relationship, improved intra-couple communication and enhanced sexual and reproductive health decision-making.ConclusionOfficial invitation letters are a feasible intervention in a resource limited sub-Saharan African context, they are highly accepted by couple members, and are an effective way to encourage men to attend ANC and CVCT. Pre-intervention CVCT rates were improved in all sites. However, urban settings might require extra emphasis to reach high rates of partner attendance compared to smaller rural health centres.

Home-Based HIV Testing Among Pregnant Couples Increases Partner Testing and Identification of Serodiscordant Partnerships

“…Furthermore, the HOPE intervention reached more men than other interventions reported in the literature, including invitation plus phone and in-person tracing of male partners to come to the clinic for testing (52% of men), 28 home-based door-to-door testing (only 28% of those met in the home were men, and 75% of household members were tested), 32 and written invitations alone without follow-up (up to 54% effectiveness). 26 However, a one-size-fits-all approach may not be as efficient as leveraging multiple strategies, which would be reasonable given that invitations and partner tracing to come to clinic have recently demonstrated reaching a relatively high proportion of men in the studies by Osoti et al 27 and Rosenberg et al 28 published in 2015. Each of these methods could be included as part of an escalating strategy of male partner involvement during the antenatal period, starting with invitations then phone tracing to attend clinic, and scheduled home-based visits for those who are not reached with the first methods.…”

Factors Associated with PMTCT Cascade Completion in Four African Countries

“…In Kenya, HIV-infected pregnant women who reported that their partner had been tested for HIV had lower rates of vertical transmission and infant mortality, but awareness of partner HIV status was not captured [36]. Current interventions to improve PMTCT partner testing include mailed invitations and home-based HIV testing procedures [37–41]. Although our study did not capture disclosure information, HIV status disclosure during pregnancy (to anyone, but particularly to the male partner) has been associated with ARV use in PMTCT [15, 42, 43].…”

Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness

“…Fraction of husbands of married pregnant women who get tested if given invitation letters 0.33 0.15-0.53 [74][75][76][77][78] OR for effect of marriage on probability of pregnant women's partner getting tested 4.00 - 76,79,80 OR for effect of self-testing offer on uptake of testing 8.17 6.33-10.24 16 Probability of starting ART soon after diagnosis Table 1. HIV testing assumptions.…”