Reaching hard-to-reach men through home-based couple HIV testing among pregnant women and their male partners in western Kenya: a qualitative study

Abstract

Background: Globally only 79% of adults living with HIV (human immunodeficiency virus) know their status and men in sub-Saharan Africa are considered a particularly hard-to-reach population for HIV testing. Home-based HIV couple testing during the antenatal period is a safe and effective method that has been used to test male partners of pregnant women. The goal of this qualitative study was to identify elements that made couple testing successful and describe important characteristics of this home-based intervention from couples' perspectives. Methods: Couples who received scheduled home-based couple testing during pregnancy in Kisumu, Kenya, were purposively sampled based on HIV status from January to May 2015. An interviewer administered all of the in-depth interviews and two coders were directly involved in the data analysis and reconciled codes several times in the process. Results: Twenty-one couples were enrolled: 9 concordant HIV-negative couples, 8 HIV discordant couples, 3 HIV concordant HIV-positive couples, and 1 whose concordance status was unknown. Median age at the time of home-based couple testing was 24 and 28 years for women and men, respectively. Median relationship duration was 3 years and couples had a median of two pregnancies. The major themes that emerged were that homebased couple testing 1) removed the female burden of requesting couple testing, 2) overcame logistical barriers associated with clinic-based testing, 3) encouraged participants to overcome their fear of testing and disclosure, 4) provided privacy in the home, and 5) provided quality time with the health advisors. Importantly, some women appreciated individual testing at the clinic before couple testing and some couples preferred skilled, anonymous health advisors delivering the intervention rather than known community health workers.

Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

“…Of these, 81 studies were included in the meta‐analysis [33–113] and 29 studies were included in the meta‐synthesis [105,114–141]. Our updated searches identified 48 additional studies for the meta‐analysis [142–189] and 11 additional studies for the meta‐synthesis [190–200], most published in 2020.…”

“…Our updated searches identified 48 additional studies for the meta-analysis and 11 additional studies for the meta-synthesis [190][191][192][193][194][195][196][197][198][199][200], most published in 2020. Most studies reporting on knowledge of positive status asked participants about their status prior to testing in the study (33/47 [70.2%]), whereas some studies provided unclear details (7/47 [14.9%]) or used other methods (7/47 [14.9%]), including asking about knowledge of status after testing within the study.…”

Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa

“…This finding highlights the importance of offering PrEP to women independent of whether their partner has been diagnosed and disclosed serostatus. One-third of men with HIV (MWH) in South Africa do not know their serostatus [ 58 ], and less than half of women are aware of their partner's serostatus [ 59 , 60 ]. Interventions to promote knowledge of partner serostatus remain important, but should not undermine opportunities to provide PrEP to women who may not know their partner's serostatus but live in an HIV-endemic area or otherwise feel vulnerable to HIV [ 48 ].…”

Barriers, Facilitators, and Strategies to Improve Participation of a Couple-Based Intervention to Address Women’s Antiretroviral Therapy Adherence in KwaZulu-Natal, South Africa

“…However, the definition of what it means to be a provider extends beyond economic provision and can include supporting the safety, health, and well-being of female partners and children [33]. By bringing men into care to support women, it may also be an opportunity to address men's own HIV needs, which often go unaddressed; however, this has mostly been examined in the context of antenatal care [34,35]. CBIs and other family-based approaches may be a strategy to engage men in care for their own health and well-being.…”