Abstract
BackgroundMale involvement (MI) along the continuum of HIV healthcare services has been promoted as a critical intervention in low-income countries and represents one of the reasons for dropout and low retention of women along the cascade of care. The present review aims to identify interventions adopted to improve MI across Antenatal Clinics (ANCs).MethodsFor this systematic review, we searched electronic databases, including Scopus, PubMed, Web of Science (from 2008 to 2018) in English language. We included all interventions explicitly aimed at involving partners in pregnant women’s HIV continuum of care and we excluded studies performed in developed countries, not involving pregnant women. We followed the PRISMA checklist.ResultsWe identified a total of 1694 records and excluded 1651 after duplicates were removed and abstract eligibility assessments were performed. Forty-three full-text articles were screened, but only 12 studies were included. Recurrent intermediate outcomes were antenatal partner attendance rate and male HIV testing. We subdivided articles according to the type of intervention: single intervention (7) and multiple interventions (5). Among single interventions, two studies evaluated the use of an invitation letter sent via women to encourage male attendance to the ANC. Four Randomized Controlled Trials (RCTs) compared the invitation card (standard of care, SC) to word of mouth, information letter, home visit and invitation card plus partner tracing. The partner attendance rate was lower in SC than in the intervention arm in three RCTs: information letter (14.2% vs 16.2%), home-visit (39% vs 87%) and invitation card plus partner tracing (52% vs 74%). Home visit strategies seemed the most effective. One study evaluated words of encouragement adopted to trigger women to invite their partners.Among multiple interventions, the most effective strategies in terms of male attendance included health promotion through education and healthcare worker development. These interventions were more likely to be effective in promoting MI than single interventions.ConclusionsFrom the review emerges the importance of male involvement in HIV cascade for pregnant women in countries with a significant HIV incidence and the need to define more precise indicators for measuring MI.
Highlights
Male involvement (MI) along the continuum of HIV healthcare services has been promoted as a critical intervention in low-income countries and represents one of the reasons for dropout and low retention of women along the cascade of care
The reasons for the exclusion were: the studies did not assess an intervention, they were qualitative studies, the study population was from high-income countries, they were focused on special population groups, and they were based on clinical trial not yet concluded
Of these 31 were subsequently excluded for the following reasons: they were not focused on male involvement or related interventions; they were research protocols; they were qualitative papers; the aim of the study was not related to male involvement, attendance, accompanying and testing. 12 full-text papers were included in the review (Fig. 1)
Summary
Male involvement (MI) along the continuum of HIV healthcare services has been promoted as a critical intervention in low-income countries and represents one of the reasons for dropout and low retention of women along the cascade of care. Male involvement (MI) represents a critical issue in maternal and child healthcare services in developing countries [2] and is associated with improved maternal adherence and retention [3,4,5] and reduction of infant HIV infection [6,7,8]. The lack of male partner involvement along the continuum of HIV healthcare services represents one of the main reasons for treatment refusal, delayed enrolment, dropout and low retention of pregnant and breastfeeding women [2, 9, 10]. Across Sub-Saharan Africa (SSA), the knowledge of HIV status is lower in men and boys than in women and girls living with HIV [13]
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