Involvement of partner in VCT increases uptake of interventions to prevent vertical and sexual HIV transmission
Michael Carter
2004-12-17
Partner participation in HIV voluntary counselling and testing (VCT) of pregnant women receiving antenatal care in Nairobi was associated with an increased uptake of treatment to prevent mother-to-baby transmission of HIV and of condom use, according to a study published in the December 15th edition of the Journal of Acquired Immune Deficiency Syndromes. The investigators believe that their study demonstrates the feasibility and need to involve male partners in VCT HIV prevention initiatives.
Evidence from earlier studies suggests that a lack of support from partners impedes the
uptake of treatment to prevent mother-to-baby transmission of HIV and behavioural change to
prevent the sexual transmission of HIV.
Current VCT practices usually involve counselling and testing women alone in the expectation
that she will then inform her partner if she is HIV-positive. However, the majority of
pregnant women in regular partnerships who test HIV-positive during routine care do not
inform their partners of their health status because of a fear of violence, relationship
breakdown or social stigma.
Investigators in Nairobi hypothesised that involving the partners of pregnant women in VCT
would facilitate partner notification and partner involvement in decisions about the
prevention of mother-to-baby transmission of HIV and safer sex.
Study design
Women attending an antenatal clinic in Nairobi were recruited to the study during their first
visit. The women were informed about sexual and mother-to-baby transmission of HIV and
encouraged to inform their partners about the availability of VCT. The women were asked to
return a week later for routine antenatal tests and optional VCT. They were given the choice
of attending for VCT alone or with their partner.
Based on their initial preference, women and their partners received post-HIV test
counselling either individually or together. All individuals were asked to return two weeks
later when HIV-positive women and their partners were counselled about the prevention of
mother-to-baby transmission of HIV, including nevirapine use, the importance of not
breastfeeding, and the use of formula feed as a substitute. All HIV-positive women were
offered both maternal and infant doses of nevirapine.
A week after delivery, HIV-positive women were asked to say if their baby received nevirapine
and to describe the method of infant feeding they were using. The women and their babies were
asked to return after three and six months for additional counselling and the optional HIV
testing of the baby.
Results
Between September 2001 and December 2002 a total of 2104 women accepted VCT at the clinic and
1991 women (89%) reporting asking their partners to accompany them.
Of the 308 couples that came for VCT, 116 (38%) decided to have their post-test counselling
together. Just over half (170, 55%) of the men who attending for the first VCT visit came
back for further counselling on the prevention of HIV transmission after receiving their HIV
test result.
Total HIV prevalence was 14% (314 individuals) amongst the 2104 women tested and 11% among
the 314 men tested.
Just over two-thirds (217) of the HIV-positive women returned for further counselling two
weeks after receiving their result, a significantly lower proportion than the 79% of
HIV-negative women who returned at this stage (p = 0 .001).
Only 122 HIV-positive women attend for a follow-up appointment during the first week after
delivery to evaluate nevirapine use by their baby and the mode of infant feeding. In total 67
infants were tested for HIV at three months of age and 8 (12%) were infected with HIV.
Partner notification and VCT
HIV prevalence was significantly lower amongst women who attended VCT with their partners
(10% versus 16%, p = 0.02). Living with a partner, being married, being in a monogamous
relationship, and older age of sexual debut were all associated with attending VCT with a
partner.
In total 64% of HIV-positive women informed their partners of their HIV test result compared
to 95% of women testing HIV-negative (p < 0.001). Informing a partner of the results of an
HIV test was associated with unemployment, living with a partner, being married, fewer
life-time sexual partners, older age of sexual debut, and testing HIV-negative.
Nevirapine use
In total 200 of the 314 HIV-positive women (64%) received nevirapine. Of the 113 women who
attended for a counselling visit after labour, 111 (91%) reported taking a nevirapine dose
during labour and 108 (89%) said that their infant had received a dose of nevirapine.
The investigators established that 83% of women who underwent VCT with their partner received
nevirapine compared to 71% of women who were counselled separately from their partner, and
56% of women whose partner did not attend for VCT (trend, p = 0.02).
Nevirapine use during delivery also followed a similar trend (88% VCT with partner, 67% VCT
separately, 45% no partner VCT, p = 0.006).
Women whose partners came for VCT were three times more likely to receive nevirapine (p =
0.02), and over three times more likely to report using the maternal or infant dose of
nevirapine during labour (p = 0.009).
Couple VCT was also significantly associated with attending for counselling sessions after
delivery, with women who received VCT as a couple eight times more likely to attend the three
month follow-up appointment and report nevirapine use at birth (p = 0.03).
Breastfeeding
Women who received VCT with their partner were significantly less likely to breastfeed (p =
0.03).
At three months post-delivery, the investigators found a trend for partner notification to be
associated with lower rates of HIV infection in infants (p = 0.07).
Prevention of sexual transmission of HIV
In total 95 women reported having sex after being told they were HIV-positive. Partner
notification of the result of the HIV test result was associated with significantly higher
levels of condom use (p = 0.004), and VCT with a partner was associated with a trend towards
more condom use post HIV diagnosis (p = 0.07).
Among HIV-infected women presenting for routine antenatal care in this cohort, partner
participation in VCT was associated with increased uptake of interventions to prevent
vertical and sexual transmission of HIV, write the investigators. Although the investigators
acknowledge that it was a challenge to involve partners in VCT they conclude that their
findings support couple counselling as a strategy to reduce perinatal HIV transmission and
emphasise the need for feasible, affordable approaches to encourage men to participate in VCT
and couple counselling.
( Source: Aidsmap, Monday, December 13, 2004)
Reference
Farquhar C et al. Antenatal couple counseling increases uptake of interventions to prevent
HIV-1 transmission. J Acquir Immune Defic 37: 1620 1626, 2004
|
Mother-to-child transmission may be more common with subtype D than A
(2005-08-19)
ANC coverage
(0000-00-00)
HISA 2006 Conference
(2006-05-03)
Women, Children and HIV
HST Conference 2007: Accommodation
(2007-08-31)
News
