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

Abstract

Introduction HIV testing male partners of pregnant and postpartum women can lead to improved health outcomes for women, partners and infants. However, in sub‐Saharan Africa, few male partners get HIV tested during their partner's pregnancy in spite of several promising approaches to increase partner testing uptake. We assessed stakeholders’ views and preferences of partner notification, home‐based testing and secondary distribution of self‐test kits to understand whether offering choices for partner HIV testing may increase acceptability. Methods Interviewers conducted semi‐structured interviews with HIV‐negative (N = 39) and HIV‐positive (N = 41) pregnant/postpartum women, male partners of HIV‐negative (N = 14) and HIV‐positive (N = 14) pregnant/postpartum women, healthcare workers (N = 19) and policymakers (N = 16) in Malawi and Zambia. Interviews covered views of each partner testing approach and preferred approaches; healthcare workers were also asked about perceptions of a choice‐based approach. Interviews were transcribed, translated and analysed to compare perspectives across country and participant types. Results Most participants within each stakeholder group considered all three partner testing strategies acceptable. Relationship conflict was discussed as a potential adverse consequence for each approach. For partner notification, additional barriers included women losing letters, being fearful to give partners letters, being unable to read and men refusing to come to the clinic. For home‐based testing, additional barriers included lack of privacy or confidentiality and fear of experiencing community‐level HIV stigma. For HIV self‐test kits, additional barriers included lack of counselling, false results and poor linkage to care. Preferred male partner testing options varied. Participants preferred partner notification due to their respect for clinical authority, home‐based testing due to their desire to prioritize convenience and clinical authority, and self‐test kits due to their desire to prioritize confidentiality. Less than half of couples interviewed selected the same preferred male partner testing option as their partner. Most healthcare workers felt the choice‐based approach would be acceptable and feasible, but noted implementation challenges in personnel, resources or space. Conclusions Most stakeholders considered different approaches to partner HIV testing to be acceptable, but concerns were raised about each. A choice‐based approach may allow women to select their preferred method of partner testing; however, implementation challenges need to be addressed.

The power of partners: positively engaging networks of people with HIV in testing, treatment and prevention

“…Understanding the perspectives of communities affected by HIV, potential clients and their partners, and healthcare workers who are or will be performing PNS is necessary for the development and implementation of effective, safe and scalable programmes. Articles from this supplement provide new perspectives on PNS for key and vulnerable populations and pregnant and postpartum women as well as how PNS can be integrated into both HIV care and prevention programmes .…”

“…Providers and clients were able to identify multiple strategies for addressing these concerns and employ PNS safely and effectively. Finally, pregnant women, their male partners, healthcare workers and policymakers from Zambia and Malawi considered multiple options for testing male partners of pregnant women . As no single approach was overwhelmingly preferred within or across stakeholder groups and all had multiple pros and cons, the authors concluded that a choice‐based approach may result in greatest uptake of these services and enhance their impact.…”

Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: a qualitative study from urban Blantyre, Malawi

“…Antenatal care (ANC) presents an opportunity for health screening to both the female and male expectant partners [ 1 ]. For example, up to 94% of women attending ANC accept to test for HIV globally [ 2 ].…”

Identifying Barriers to Disclosure to Overcome Barriers to ART Initiation: An explanatory qualitative study on PMTCT in Zambia

“…Furthermore, one of the major deterrents to initiation and sustained adherence has been the lack of male involvement in ART care as women need to discuss their HIV status with their husbands before deciding to start ART [6][7][8]. Men's attitude to joining Prevention of Mother to Child Transmission (PMTCT) in sub-Saharan Africa has been linked to cultural expectations and the social norm that hold women responsible for attending PMTCT [9].…”