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Home Visits during Pregnancy Enhance Male Partner HIV Testing: A Randomized Clinical Trial

Home Visits during Pregnancy Enhance Male Partner HIV Testing: A Randomized Clinical Trial. Alfred Osoti MBChB MMed MPH Department of Epidemiology University of Washington. 7 TH IAS Conference on HIV Pathogenesis, Treatment and Prevention . Benefits of m ale p artner involvement.

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Home Visits during Pregnancy Enhance Male Partner HIV Testing: A Randomized Clinical Trial

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  1. Home Visits during Pregnancy Enhance Male Partner HIV Testing: A Randomized Clinical Trial Alfred Osoti MBChB MMed MPH Department of Epidemiology University of Washington 7TH IAS Conference on HIV Pathogenesis, Treatment and Prevention

  2. Benefits of male partner involvement HIV infected pregnant woman HIV uninfected pregnant woman Reduce high maternal HIV incidence in discordant relationships • Improve uptake of PMTCT • Enhance infant HIVfree survival Aluisioet al. JAIDS 2011 Kinuthia et al. CHR 2010

  3. Male partner involvement is low www.pepfar.gov/press/81257.htm • Male HIV testing considered “marker” of male partner involvement • All studies were facilitybased *Cameroon, India, Georgia, Dominican Republic

  4. Enhancing male partner involvement • How else can we reach these men if they will not come to clinic?

  5. Home-based HIV Counseling and Testing (HBCT) Alsop Z. Lancet 2010. Naik BMC Public Health 2012. • Door-to-door HBCT • Acceptability >70% • Testers ~25% men ~13% couples ≈4% pregnancy • For PMTCT, it may be more efficient to focus on testing men when their partners are pregnant

  6. Men as Partners in PMTCT (MAP) study Primary objective • Compare effectiveness of home visitvs. invitationfor clinic visit in increasing male partner HIV counseling and testing among women seeking prenatal care Secondary objectives • Evaluate relationship stability and intimate partner violence following male partner HIV testing

  7. Study population and setting • HIV prevalence • Study population • Pregnant women unaccompanied by partners • On 1st antenatal care (ANC) visit • Legal age • No couple HCT in this pregnancy • Reside in area with partner for ≥ 6 weeks • Ahero Sub-district Hospital, Nyanza, Kenya • Antenatal HIV-1 prevalence ~ 20% Nyanza 13.9% National 6.3%

  8. Design: a randomized controlled trial Screening, Enrollment, Interview [Audio Computer Assisted SelfInterview (ACASI)] Randomization Antenatal HCT Invitation for Clinic Visit (ACASI & Couple HCT) Immediate Home Visit (ACASI & Couple HCT) Male partners tested for HIV, through Couple HCT • Intimate partner violence • Relationship stability

  9. Results: Enrollment and follow-up of women 495 screened during 1st ANC visit 183 (37%) ineligible 312 (63%)eligible 12 (4%) declined 300 (96%) randomized 150 home visit 150 clinic visit 1 loss to follow-up 149 (99%) followed-up 150 (100%) followed-up

  10. Results: baseline characteristics of women $=United States dollars

  11. Results: male partner access and HIV testing HOME VISIT (150 women enrolled) CLINIC VISIT (150 women enrolled) 133 (89%) male partners accessed 55 (37%) male partners accessed 128 (85%) male partners HIV tested 54 (36%) male partners HIV tested

  12. Results: Main outcomes *Statistically significant RR=Relative Risk CI= Confidence interval

  13. Results: overall male partner HIV status *Statistically significant RR=Relative Risk CI= Confidence interval

  14. Results: relationship status at follow-up P<0.001 P= 0.767 P=1.000

  15. Strengths and limitations Strengths Limitations Excluded single and those in unstable relationships Short follow-up period, unable to assess long-term outcomes such as HIV free survival, linkage to care, cost-effectiveness • Randomized design • Generalizable to high HIV prevalence and resource-limited settings with similar partnerships • Easily implementable, conducted after routine prenatal HCT

  16. Conclusions • Home visits for male partner testing and mutual disclosure • highly acceptable • enhanced access to male partners and couple HCT (85%) • did not adversely affect short-term relationship status • found high prevalence of • HIV among male partners • HIV serodiscordant couples

  17. Acknowledgements University of Nairobi James Kiarie John Kinuthia • Study Participants and Staff Funding: NIH , Fogarty International Centre University of Washington Carey Farquhar Grace John-Stewart Barbra Richardson Daisy Krakowiak International AIDS Research and Training Program

  18. THANK YOU!

  19. Enrollment status • Ineligibility (n=183): • 14 accompanied by male partner • 32 male partners or themselves away for > 6 weeks • 53 HIV positive and knew before pregnancy • 38 single with no stable male partner • 25 single, primary to high school students • 9 separated from male partners • 2 widows • 2 non-pregnant (negative pregnancy test) • 8 visitors, not residents of the area • Reasons for declining (n=12): • 5 consult partner • 4 time constraints • 3 another study

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