Abstract
BackgroundHIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy.MethodsA randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing.ResultsNearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication.ConclusionsHIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.
Highlights
HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa
HIV enhancement included HIV transmission and testing information, an “exchange game” and role plays practicing partner communication about sensitive topics. The impact of this type of antenatal care on partner HIV testing was fully mediated by increased partner communication, providing further evidence that improved partner communication promotes healthy reproductive behaviors for couples
We examined unpublished data from our pilot to evaluate the effect of type of ANC on partner communication and partner HIV testing outcomes during the current pregnancy
Summary
HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. In sub-Saharan Africa, where two-thirds of new HIV infections occur, routine HIV testing of pregnant women at antenatal care (ANC) and treatment for those who test positive is nearly universal [1]. HIV testing at ANC remains a critical strategy to achieve zero new infections by 2030 [2,3,4,5]. Women testing negative at their first ANC visit remain at risk for new infection as do their infants [6, 7]. Providing HIV self-testing (HIVST) to women at ANC for their partner is another strategy that has been implemented in Ugand and Malawi [10, 11]. Cultural and structural barriers, including gender and age inequalities, norms against discussing sexuality, employment demands, poverty, and transportation difficulties, hinder HIV testing for male partners at ANC [12,13,14,15]
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