Engaging men in antenatal care: a win-win for healthy families

Male partner participation in antenatal clinic services is associated with improved HIV-free survival among infants in Nairobi, Kenya: a prospective cohort study.

Aluisio AR, Bosire R, Bourke B, Gatuguta A, Kiarie JN, Nduati R, John-Stewart G, Farquhar C. J Acquir Immune Defic Syndr. 2016 Oct 1;73(2):169-76. doi: 10.1097/QAI.0000000000001038.

Objective: This prospective study investigated the relationship between male antenatal clinic (ANC) involvement and infant HIV-free survival.

Methods: From 2009 to 2013, HIV-infected pregnant women were enrolled from 6 ANCs in Nairobi, Kenya and followed with their infants until 6 weeks postpartum. Male partners were encouraged to attend antenatally through invitation letters. Men who failed to attend had questionnaires sent for self-completion postnatally. Multivariate regression was used to identify correlates of male attendance. The role of male involvement in infant outcomes of HIV infection, mortality, and HIV-free survival was examined.

Results: Among 830 enrolled women, 519 (62.5%) consented to male participation and 136 (26.2%) men attended the ANC. For the 383 (73.8%) women whose partners failed to attend, 63 (16.4%) were surveyed through outreach. In multivariate analysis, male report of previous HIV testing was associated with maternal ANC attendance (adjusted odds ratio = 3.7; 95% CI: 1.5 to 8.9, P = 0.003). Thirty-five (6.6%) of 501 infants acquired HIV or died by 6 weeks of life. HIV-free survival was significantly greater among infants born to women with partner attendance (97.7%) than those without (91.3%) (P = 0.01). Infants lacking male ANC engagement had an approximately 4-fold higher risk of death or infection compared with those born to women with partner attendance (HR = 3.95, 95% CI: 1.21 to 12.89, P = 0.023). Adjusting for antiretroviral use, the risk of death or infection remained significantly greater for infants born to mothers without male participation (adjusted hazards ratio = 3.79, 95% CI: 1.15 to 12.42, P = 0.028).

Conclusions: Male ANC attendance was associated with improved infant HIV-free survival. Promotion of male HIV testing and engagement in ANC/prevention of mother-to-child transmission services may improve infant outcomes.

Abstract access [1]

Editor’s notes: Although new HIV infections among children have declined by a striking 50% since 2010, 150 000 children [110 000–190 000] worldwide became newly infected with HIV in 2015. Getting to zero and achieving virtual elimination of mother-to-child HIV transmission will require all hands on deck – and that includes fathers. This study has several limitations but its findings stand: lack of involvement by fathers in the antenatal care (ANC) of their HIV-positive pregnant partner increased four-fold their offspring’s risk of death or HIV infection by six weeks of life. How exactly ANC involvement of fathers might increase the HIV-free survival of their babies is unclear. In multivariate analysis, only male report of previous HIV testing was associated with men’s ANC engagement. However, factors found significant in univariate analysis were: disclosure of HIV-positive status by women, mutual discussion of mother-to-child transmission, having undergone couples voluntary counselling and testing, and being in a monogamous partnership. There was no difference between men who attended and men who did not in terms of age, employment status, or level of education – all of which one might think could be associated with male engagement in ANC. These results beg more questions. Given the HIV-survival benefits for children, how can we enhance male HIV testing and ANC involvement? In country after country, men living with HIV are less likely to know their serostatus than are women. They are therefore less likely to start antiretroviral treatment in a timely manner to reap its clinical benefits for themselves and reduce the risk of HIV transmission for others. Trials are necessary to test innovative strategies to reach men with HIV testing, on their own or through couples testing and by location such as at work sites, in community service settings, at sporting and other special events, through home-based testing, and in the context of antenatal care. Mixed methods studies are necessary to better understand beneficial partnership characteristics and individual barriers and facilitators of male involvement in antenatal care. The results would inform the design of effective programmes and approaches. The benefits for the father, mother, and baby of enhanced male engagement in ANC might go well beyond HIV to encompass the health of all family members. 

 

Africa [5]
Kenya [6]
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