Strategies to improve male involvement in PMTCT Option B+ in four African countries: a qualitative rapid appraisal

Abstract

BackgroundThe World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This ‘test and treat’ approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT). This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Côte d'Ivoire in the context of scale-up of Option B+ protocol.DesignData were collected through qualitative rapid appraisal using focus groups and individual interviews during field visits to the four countries. Interviews were conducted in the capital city with Ministry of Health staff and implementing partners (IPs) and at district level with district management teams, facility-based health workers and community health cadres in each country.ResultsCommon strategies were adopted across the countries to effect social change and engender greater participation of men in maternal, child and women's health, and PMTCT services. Community-based strategies included engagement of community leaders through dialogue and social mobilization, involving community health workers and the creation and strengthening of male peer cadres. Facility-based strategies included provision of incentives such as shorter waiting time, facilitating access for men by altering clinic hours, and creation of family support groups.ConclusionsThe approaches implemented at both community and facility levels were tailored to the local context, taking into account cultural norms and geographic regional variations. Although intentions behind such strategies aim to have positive impacts on families, unintended negative consequences do occur, and these need to be addressed and strategies adapted.A consistent definition of ‘male involvement’ in PMTCT services and a framework of indicators would be helpful to capture the impact of strategies on cultural and behavioral shifts. National policies around male involvement would be beneficial to streamline approaches across IPs and ensure wide-scale implementation, to achieve significant improvements in family health outcomes.

Roles and Expectations of Male Partners from PMTCT services in Chiradzulu Malawi: A Qualitative Study

“…This approach which is builds upon community based strategies ensures that influential and men learn about their roles from health care workers in environments of comfort [14]. This approach would encourage community members to understand the new concepts which would promote behaviour change.A community's supportive attitudes towards PMTCT services will give a symbol about a changed cultural environment that permits and expects male partners to be involved in PMTCT services [14].…”

“…Optimal delivery of community services is influenced by prior stakeholders mapping and collaboration, integration within pre-existing services and creation of peer support groups. Earlier studies highlighted the provision of community services through collaboration with different stakeholders [10,13,14,30,56]. The stakeholders include church leaders, traditional leaders, health care workers who can convey PMTCT messages in various forums [10,30,56].…”

“…The stakeholders include church leaders, traditional leaders, health care workers who can convey PMTCT messages in various forums [10,30,56]. It is believed that men are likely to change their views towards PMTCT when messages are shared at a church or a mosque which may result in an increase in participation in PMTCT services [14,15,29]. A multi country study done in Sub Saharan Africa reported that negotiating with community partners and working with leaders helped dismiss myths and fears around HIV and addressed challenges with stigma [56].…”

Roles and Expectations of Male Partners from PMTCT services in Chiradzulu Malawi: A Qualitative Study

“…This finding requires careful consideration because it may discriminate women without partners or are in unstable relationships [41]. Related to space was the need for privacy which has been reported in earlier studies [13,14].…”

“…Several strategies have been implemented to improve male involvement (MI) in PMTCT service [14][15][16] but have yielded a suboptimal uptake [17]. Even with the documented strategies like: engaging influential community leaders and community-based workers; creating male peer support groups; providing incentives such as checking blood pressure, deworming, height measurement, HIV and syphilis screening; and attending to couples earlier than women who come alone [14][15][16], the rates of MI have remained low. For instance, in Uganda implementation of the strategies only improved couple HIV testing rates from 12% in 2013 to 20% in 2015 [17].…”