Male Partner HIV Testing Research Articles

Efficacy of mobile phone intervention to increase male partner antenatal care attendance for HIV testing in Moshi municipal, Tanzania: a randomized controlled trial

BackgroundHIV partner counselling and testing in antenatal care (ANC) is a crucial strategy to raise the number of males who know their HIV status. However, in many settings like Tanzania, male involvement in antenatal care remains low, and there is a definite need for innovative strategies to increase male partner involvement. This study was designed to evaluate the efficacy of mobile phone intervention increase male partner ANC attendance for HIV testing in Moshi municipal, Tanzania.MethodsBetween April and July 2022, we enrolled pregnant women presenting to a first ANC visit at Majengo and St. Joseph reproductive health facilities without their male partners. Eligible pregnant women were randomly assigned to invitation of their male partners either via phone calls, text messages from clinic staff and verbal invites from pregnant partners (intervention arm) or verbal invites only from the pregnant partners (control arm). Neither healthcare provider nor participant were blinded. The primary outcome was the proportion of male partners who attended ANC with their pregnant partners during a follow-up period of two consecutive visits. The secondary outcome measure was HIV testing among male partners following the invitation. Participants were analyzed as originally assigned (intention to treat).ResultsA total of 350 pregnant women presenting to ANC for the first time were enrolled, with 175 women enrolled in each arm. The efficacy of male attendance with their pregnant women following the invitations was 83.4% (147/175) in the intervention arm and 46.3% (81/175) in the control arm. Overall, the results suggest a positive and statistically significant average treatment effect among men who received mobile phone intervention on ANC attendance. For the secondary outcome, the percent of male partners who accepted HIV counselling and testing was 99.3% (146/147) in the intervention arm and 93.8% (76/81) in the control arm. Married men were having higher odds of ANC attendance compared with single men (aOR:6.40(3.26–12.56), Males with multigravida women were having lower odds of ANC attendance compared with primigravida women (aOR:0.17(0.09–0.33).ConclusionThe study demonstrates that supplementing verbal invitations with mobile phone calls and text messages from clinic staff can significantly increase male partner ANC attendance and HIV testing. This combined approach is recommended in improving ANC attendance and HIV testing of male partners who do not accompany their pregnant partners to antenatal clinics in the first visits.Trial registrationPACTR202209769991162.

Two strategies for partner notification and partner HIV self-testing reveal no evident predictors of male partner HIV testing in antenatal settings: A secondary analysis.

To meet global targets for the elimination of mother-to-child HIV transmission, tailored approaches to HIV testing strategies need prioritizing. Herein, we sought to identify individual-level factors associated with male partner HIV testing. We conducted a secondary analysis of data from two parallel randomized trials of pregnant women living with HIV and those HIV-negative in Lusaka, Zambia. Across both trials, control groups received partner notification services only, while intervention groups received partner notification services plus HIV self-test kits for their partners. Associations between baseline factors and male partner testing were estimated using a probability difference. The outcome of interest was uptake of male partner HIV testing of any kind within 30days of randomization. The parent study enrolled 326 participants. Among the 151 women in the control groups, no clear associations were noted between maternal or male partner characteristics and reported uptake of male partner HIV testing. There were positive trends favouring partner testing among women who completed primary school education, had larger households (>2 members), and whose partners were circumcised. Likewise, no clear predictors of male partner testing were identified among the 149 women in the intervention groups. However, negative trends favouring no testing were noted among older, multiparous women from larger households. No consistent predictors for male partner HIV testing across two compared strategies were observed. Our findings suggest that differentiated strategies for male partner HIV testing may not be necessary. Instead, consideration should be given to universal approaches when bringing such services to scale.

Perspectives and experiences of Zambian pregnant and postpartum women receiving two intervention models to increase uptake of male partner HIV testing

ABSTRACT This study explored the experiences of pregnant women who received two intervention models for increasing uptake of male partner HIV testing in antenatal settings. As part of a randomised trial, we interviewed twenty participants who received partner notification services only while 22 received the partner notification plus HIV self-testing. Thematic analysis was used to analyse the data. Partner notification services helped to initiate discussions of HIV testing with partners, influence partners to undergo testing, and encouraged disclosure of HIV status. Some women experienced difficulties engaging partners due to fear of their partner's reaction. Some partners were unable to test due to time constraints. The partner notification plus HIV self-testing intervention, stimulated discussion about HIV testing; facilitated testing for men at their convenience; addressed privacy/confidentiality, and stigma concerns; and provided the opportunity to disclose HIV status. Some women feared disclosure and retribution in case of discordance results. There were also challenges with men making follow-ups for confirmatory HIV tests. The addition of HIV self-test kits to partner notification services can expand HIV testing services to male partners, including those of HIV-negative women. Additional efforts are needed to link men to appropriate HIV prevention, care, and treatment services.

Addition of HIV self-test kits to partner notification services to increase HIV testing of male partners of pregnant women in Zambia: two parallel randomised trials

SummaryBackgroundTesting men for HIV during their partner’s pregnancy can guide couples-based HIV prevention and treatment, but testing rates remain low. We investigated a combination approach, using evidence-based strategies, to increase HIV testing in male partners of HIV-positive and HIV-negative pregnant women.MethodsWe did two parallel, unmasked randomised trials, enrolling pregnant women who had an HIV-positive test result documented in their antenatal record (trial 1) and women who had an HIV-negative test result documented in their antenatal record (trial 2) from an antenatal setting in Lusaka, Zambia. Women in both trials were randomly assigned (1:1) to the intervention or control groups using permuted block randomisation. The control groups received partner notification services only, including an adapted version for women who were HIV-negative; the intervention groups additionally received targeted education on the use of oral HIV self-test kits for their partners, along with up to five oral HIV self-test kits. At the 30 day follow-up we collected information from pregnant women about their primary male partner’s HIV testing in the previous 30 days at health-care facilities, at home, or at any other facility. Our primary outcome was reported male partner testing at a health facility within 30 days following randomisation using a complete-case approach. Women also reported male partner HIV testing of any kind (including self-testing at home) that occurred within 30 days. Randomisation groups were compared via probability difference with a corresponding Wald-based 95% CI. The trial is registered at ClinicalTrials.gov (NCT04124536) and all enrolment and follow-up has been completed.FindingsFrom Oct 28, 2019, to May 26, 2020, 116 women who were HIV-positive (trial 1) and 210 women who were HIV-negative (trial 2) were enrolled and randomly assigned to study groups. Retention at 30 days was 100 (86%) in trial 1 and 200 (95%) in trial 2. Women in the intervention group were less likely to report facility-based male partner HIV testing in trial 1 (3 [6%] of 47 vs 15 [28%] of 53, estimated probability difference −21·9% [95% CI −35·9 to −7·9%]) and trial 2 (3 [3%] of 102 vs 33 [34%] of 98, estimated probability difference −30·7% [95% CI −40·6 to −20·8]). However, reported male partner HIV testing of any kind was higher in the intervention group than in the control group in trial 1 (36 [77%] of 47 vs 19 [36%] of 53, estimated probability difference 40·7% [95% CI 23·0 to 58·4%]) and trial 2 (80 [78%] of 102 vs 54 [55%] of 98, estimated probability difference 23·3% [95% CI 10·7 to 36·0%]) due to increased use of HIV self-testing. Overall, 14 male partners tested HIV-positive. Across the two trials, three cases of intimate partner violence were reported (two in the control groups and one in the intervention groups).InterpretationOur combination approach increased overall HIV testing in male partners of pregnant women but reduced the proportion of men who sought follow-up facility-based testing. This combination approach might reduce linkages to health care, including for HIV prevention, and should be considered in the design of comprehensive HIV programmes.FundingNational Institutes of Health.

Getting to Zero: A Demonstration Project of Partner HIV Testing in the Prenatal Setting in Chicago, Illinois.

Women who experience HIV seroconversion during pregnancy are missed during early routine pregnancy HIV screening and are at high risk of perinatal HIV transmission. Male partner HIV testing during routine prenatal care may be an effective primary prevention strategy by identifying women at risk of seroconversion and mitigating their risk. Our objective was to assess interest in and uptake of male partner HIV testing services offered during prenatal care. This demonstration project included all pregnant, English-speaking, HIV-negative women receiving publicly funded prenatal care in an urban hospital-based practice located in a high HIV prevalence area. Women were offered free HIV screening for their male sexual partners. From April 2017 to June 2018, enrolled women completed surveys on social demographics, medical access characteristics, and HIV testing history. Women were invited to bring their partners to a prenatal visit where HIV testing was offered to their male partners. Factors associated with women's interest in testing and completion of partner testing were assessed using bivariable and multivariable analyses. Of 392 women approached, 70% (N = 274) completed study surveys. Although the majority (76%, N = 200 of 264 respondents) of women desired their partner undergo HIV testing, testing was underutilized as only 18 (7%) male partners completed testing. While neither maternal characteristics nor male social or attitudinal factors were associated with interest in or completion of partner HIV testing, sensitivity analyses, performed with multiple imputation, demonstrated some association between interest and completion of partner testing and partner medical care access and utilization. In conclusion, although the majority of low-income women in an urban prenatal clinic expressed interest in having their partners undergo HIV testing, uptake of free partner HIV testing services was uncommon. A focused assessment of implementation and uptake barriers is needed to optimize partner testing and eliminate HIV transmission to mothers and their babies.

Short Communication: Communication Between Pregnant Women and Male Partners About HIV Testing in the United States.

Male partner uptake of HIV testing during antenatal care is poor despite women's reported desire for partner testing. This qualitative study of HIV-negative pregnant women and their partners in a high HIV prevalence city in the United States assessed communication between partners about HIV testing. Facilitators and barriers of partner testing were identified. Women are the driving force behind couples' communication; however, male partner uptake is underutilized. A common barrier to male partner uptake is the concept of "negative by proxy," as well as male partner lack of follow-up for testing and nondisclosure of results. Future research is needed to assess specific barriers to male partner HIV testing as an approach to preventing perinatal HIV transmission.

Utilization of HIV Test Service Among Pregnant Women's Partners and Its Associated Factors in Selected Sub-Cities of Addis Ababa, 2019: A Community-Based Cross-Sectional Study.

BackgroundSignificant progress has been made towards achieving the 90-90-90 global targets by 2020. Nationally, 72% of HIV-positive people aged 15–64 years in urban areas were aware of their HIV status. There is low habit of male partner accompanying pregnant women during ANC visit. This study assessed the HIV test service utilization and associated factors among pregnant women’s partners in Addis Ababa.MethodsA community-based cross-sectional study design was conducted from January to February 2020 in Addis Ababa town. A multistage sampling method was used to recruit 812 participants. Data were entered into EpiData version 4.1 and analysis was done by using SPSS version 25.0. The presence and strength of significant association with outcome variables in multivariable analysis were determined with P<0.05 and at 95% CI, respectively.ResultsAmong respondents, 63.7% [95% CI (60–67%)] of pregnant woman partners had tested for HIV/AIDS. Knowledge on the route of HIV transmission from mother to child (AOR=1.9, 95% CI (1.3–2.7)), knowledge on ways of prevention of HIV from mother to child transmission (AOR=0.26, 95% CI (0.17–0.38)), previous history of couple HIV counseling (AOR=3.7, 95% CI (2.3–6.1)), discussion about HCT and ANC services with a partner (AOR=6.3, 95% CI (4.0–9.8)), heard about discordant HIV test result (AOR=1.6, 95% CI (1.4–4)) were significantly associated with partner HIV test.ConclusionHIV testing service utilization among male partners of pregnant women was good in the study area. The knowledge on ways of prevention of HIV from mother to child transmission, those who received couple HIV counseling before, those who discussed HCT at ANC services with a partner, and heard about discordant HIV test results were predictors of HIV test utilization among pregnant women partner. Therefore, increasing community awareness on the pregnant women partner testing should be planned to enhance male partner HIV testing during in antenatal care follow-up.

HIV Oral Self-Testing for Male Partners of Women Attending Antenatal Care in Central Uganda: Uptake of Testing and Linkage to Care in a Randomized Trial.

In Uganda, HIV testing rates are approximately 90% among women in antenatal care, with male rates much lower. The World Health Organization has recommended HIV self-testing (HIVST), and one promising model is for women in antenatal care to deliver HIVST kits to their male partners. We investigated the impact of this model on male partner testing rates. Three high-volume antenatal clinics in central Uganda. We implemented a cluster-randomized controlled trial comparing standard of care to intervention, with the primary outcome of self-reported male partner HIV testing. Women and male partners were followed at 1 and 3 months. We used unadjusted analyses and log-linear models with an intent-to-treat approach accounting for clustering. Study coordinators randomized 1514 women (777 intervention and 737 control). Baseline characteristics were balanced across arms with mean age (SD) of 25.2 (5.5) years and >44% with secondary education or higher. More male partners tested for HIV in intervention [576/746 (77.2%)] versus control [264/709 (37.2%)], P < 0.01. We identified 34 HIV-positive men in intervention versus 10 in control, with 6/26 (23%) and 4/6 (67%), respectively, reporting linking to care. Our results demonstrate an enormous increase in self-reported partner HIV testing when HIVST is available at home. However, men testing positive through HIVST appeared less likely to link to care than men testing positive at a clinic. These results highlight the potential of HIVST in increasing HIV testing rates, while underscoring the importance of developing effective approaches to maximizing linkage to care among those testing positive through HIVST.

Attitudes towards male partner HIV testing among low-income, minority pregnant women and their partners

ObjectivePrimary prevention of maternal HIV seroconversion requires knowledge of the HIV status of sexual partners, but testing rates, particularly among urban minority heterosexual males, remain low. This study was initiated to understand the attitudes of pregnant women and their partners surrounding partner HIV testing. MethodsThis was a qualitative study of pregnant women receiving publicly-funded prenatal care in a large urban hospital located in a high HIV prevalence area and their partners. Participants underwent in-depth individual interviews about HIV testing. Semi-structured interview guides were used to elicit participant attitudes. Transcripts were analyzed using the constant comparative method to determine themes and subthemes; analysis was organized by whether participants desired or declined partner testing. ResultsOf 51 participants, 29 were pregnant women and 22 were male partners of female participants. Reasons for desiring or declining HIV testing aligned within three major themes: risk perception, logistical considerations, and testing history. An individual’s perception of risk included evaluations of fetal safety as well as partner autonomy and fidelity. Logistical considerations included cost, test availability, and male partner geographic location. Individuals’ recent testing histories also influenced testing preferences. One cross-cutting theme was of the pregnant woman taking responsibility for family health, which could serve as a motivator to test or reason to decline. ConclusionPregnant women are often the linchpin of prevention of HIV transmission in the family unit. These data inform strategies to engage pregnant women and their partners to improve implementation of partner HIV testing in the prenatal setting.

Black Women's Approaches to Encourage Male Partners to Get Tested for HIV: Predictors of Approaches and Partner Tests.

New HIV infection rates in Black women are 15 times higher than that of White women, and new infections in women have been primarily associated with heterosexual sex. Encouraging sex partner testing may increase HIV status awareness. Prevention campaigns have not recommended specific approaches with established efficacy for women to encourage partner testing. We examined approaches to encourage HIV testing, interpersonal contexts of relationships, and HIV testing behaviors in 18- to 29-year-old Black women (n = 158). Findings from our quantitative analysis included the following: (a) Partner type (main or nonmain), intimate risk taking, sexual coercion, condom use, and age were related to varied approaches (Active Persuasion, Decisive Collaboration, Ultimatum, and Sweet Talking); (b) the greatest predictor of male partner HIV testing was whether the female partner had been tested for HIV; and (c) Active Persuasion and Decisive Collaboration approaches were associated with partner HIV testing. These findings can inform HIV prevention campaigns.

Acceptability and outcomes of distributing HIV self-tests for male partner testing in Kenyan maternal and child health and family planning clinics.

Providing HIV self-tests to women for distribution to male partners may provide a unique opportunity to increase male partner and couples testing among women in HIV high-burden settings. Between November 2017 and June 2018, we offered self-tests for at-home couples or partner HIV testing to HIV-uninfected women seeking routine maternal and child health and family planning services at eight facilities in Kisumu, Kenya. Women accepting self-tests were offered at least two self-tests (OraQuick) to take to their partner(s) with instructions on use. HIV self-testing (HIVST) outcomes were evaluated using available programmatic data. Overall, 3620 women were offered self-tests for at-home male partner HIV testing. The median age was 24 years (interquartile range 21-28) and 81% were in monogamous marriages. Overall, 1422 (39%) women reported having a partner of unknown HIV status, of whom 755 (53%) accepted self-tests. Among women with partners of unknown HIV status who declined self-tests (n = 667), 49% reported needing to consult their partner. Pregnant women were more likely to accept HIVST than nonpregnant women (prevalence ratio = 1.2, 95% confidence interval 1.0-1.4, P = 0.013). Self-testing outcomes were ascertained for 389 (44%) women who accepted self-tests. Among these women, 93% offered HIVSTs to their male partner; of these, 95% reported their male partners used the self-test and 99% used a self-test with their partner. Among women attending routine maternal and child health and family planning services who had male partners of unknown HIV status, over half accepted self-tests for partner testing. Most women with outcomes ascertained reported that male partners accepted and used self-tests and that couples testing occurred.

630: Getting to zero: a demonstration project of partner HIV testing in the prenatal setting

Although universal antenatal HIV screening identifies most women with HIV, women who are exposed to HIV and seroconvert during pregnancy remain at risk of not being identified. These women are at significantly increased risk of maternal-to-child transmission (MTCT). Implementation of male partner HIV testing in routine prenatal care has not previously been evaluated in the United States. The objective was to assess interest in and uptake of partner HIV testing services as well as characteristics associated with each. This quality improvement demonstration project included all pregnant English-speaking HIV-negative women receiving publicly funded prenatal care in a single hospital-based practice located in a high HIV prevalence urban center. Women were offered free HIV screening for their male sexual partners. From April 2017 to June 2018, enrolled women completed surveys on sociodemographic and medical access characteristics as well as HIV testing history and preferences. Women were invited to bring their partners to a prenatal visit where pre-test counseling was provided and HIV testing offered. Factors associated with pregnant women’s interest in having their partner tested and completion of partner testing were assessed. Of 392 women approached, 70% (N=274) completed study surveys. Although the majority (73%, N=200) of women desired their partner undergo HIV testing, only 18 (7%) of the partners of women who enrolled ultimately completed HIV testing (Figure). Maternal sociodemographic characteristics (age, race/ethnicity, parity, number of current sexual partners, educational, employment, and marital status) were not associated with interest in or completion of partner HIV testing. Similarly, HIV testing history, testing preferences, and medical access characteristics were not significantly associated with interest in or uptake of partner testing services (Table). Male partner HIV testing has the potential for primary HIV prevention and may be especially critical during pregnancy. Although the majority of low income women in an urban prenatal clinic expressed interest in having their partner tested, uptake of the free HIV testing services was uncommon. A focused assessment of implementation barriers is needed to optimize partner testing and eliminate HIV transmission to mothers and their babies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

267: Attitudes towards male partner HIV testing among low-income, minority pregnant women and their partners

267: Attitudes towards male partner HIV testing among low-income, minority pregnant women and their partners

2023 Relationship power imbalance and history of male partner HIV testing among pregnant women in central Uganda

OBJECTIVES/SPECIFIC AIMS: We investigated the association between relationship power imbalance (which can have a negative impact on HIV prevention) and male partner HIV testing, using baseline data from a HIV self-testing trial in 3 antenatal clinics in central Uganda. METHODS/STUDY POPULATION: Pregnant women with HIV-male partners were recruited and randomized by day into standard of care or intervention (HIV self-testing kits). Analyses were performed in SAS 9.4, with χ2 tests and p&lt;0.05 for significance. RESULTS/ANTICIPATED RESULTS: In total, 1514 women were recruited (737 standard of care, 777 intervention). Overall, 39.6% of male partners had previously tested for HIV. Among women &lt;26, contributions to expenses differed by partner testing (overall p&lt;0.001, 47.6% of women whose partners tested made no contribution vs. 63.2% of women whose partners did not test). Relationship status differed by partner testing (overall p=0.02, 12.4% of women whose partners tested showed a sometimes difficult relationship vs. 5.7% of women whose partners did not test). Among women 26+, decision making for family visits differed by partner testing (overall p=0.005, 52.9% of women made joint decisions with partners who tested vs. 36.5% whose partners did not test). DISCUSSION/SIGNIFICANCE OF IMPACT: Higher relationship power balance was associated with higher HIV testing among male partners when measured by contribution to expenses and decision making for family visits, but not relationship status. Relationship power balance should be considered when counseling women and men to increase HIV testing.

‘If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV’: HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda

ABSTRACTBackground: HIV self-testing (HIVST) can improve HIV-testing rates in ‘hard-to-reach’ populations, including men. We explored HIVST perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda.Methods: This was a qualitative study implemented as part of a pilot, cluster-randomized oral HIVST intervention trial among 1,514 pregnant women attending antenatal care services at three health facilities in Central Uganda. The qualitative component of the study was conducted between February and March 2017. We conducted 32 in-depth interviews to document women and men’s perceptions about HIVST, strategies used by women in delivering the kits to their male partners, male partners’ reactions to receiving kits from their female partners, and positive and negative social outcomes post-test. All interviews were audio-recorded, transcribed verbatim, and analyzed manually following a thematic framework approach.Results: Women were initially anxious about their male partners’ reaction if they brought HIVST kits home, but the majority eventually managed to deliver the kits to them successfully. Women who had some level of apprehension used a variety of strategies to deliver the kits including placing the kits in locations that would arouse male partners’ inquisitiveness or waited for ‘opportune’ moments when their husbands were likely to be more receptive. A few (three) women lied about the purpose of the test kit (testing for syphilis and other illnesses) while one woman stealthily took a mucosal swab from the husband. Most men initially doubted the ability of oral HIVST kits to test for HIV, but this did not stop them from using them. Both men and women perceived HIVST as an opportunity to learn about each other’s HIV status. No serious adverse events were reported post-test.Conclusion: Our findings lend further credence to previous findings regarding the feasibility of female-delivered HIVST to improve male partner HIV testing in sub-Saharan Africa. However, support for women in challenging relationships is required to minimize potential for deception and coercion.

'. . . if you bring the kit home, you [can] get time and test together with your partner': Pregnant women and male partners' perceptions regarding female partner-delivered HIV self-testing in Uganda - A qualitative study.

In 2015, the World Health Organization reported that more than 60 million people were tested for HIV in 122 low- and middle-income countries between 2010 and 2014. Despite this level of progress, over 40% of people living with HIV remain unaware of their HIV status. This calls for innovative approaches to improve uptake of HIV testing services, including use of HIV self-test (HIVST) kits. We conducted a cross-sectional, qualitative study to assess pregnant women and their male partners' perceptions regarding female partner-delivered HIVST kits. This study was conducted at two health facilities in Central Uganda between November and December 2015. Data were collected on pregnant women's willingness to take HIVST kits to their male partners and other household members using eight focus group discussions and 30 in-depth interviews. Data were analyzed following a thematic framework approach. Overall, pregnant women were willing to take HIVST kits to their partners and other household members, with the exception of their cowives. Male partners were willing to use HIVST kits brought by their female partners. Our findings suggest that secondary distribution of HIVST kits through female partners is acceptable and has the potential to improve male partner and household-member HIV testing.

Home-Based HIV Testing Among Pregnant Couples Increases Partner Testing and Identification of Serodiscordant Partnerships.

Introduction:Male partner HIV testing has been recognized as an important component of prevention of mother-to-child HIV transmission. Scheduled home-based couple HIV testing may be an effective strategy to reach men.Methods:Women attending their first antenatal visit at Kisumu County Hospital in Kenya were randomized to home-based education and HIV testing within 2 weeks of enrollment (HOPE) or to written invitations for male partners to attend clinic (INVITE). Male partner HIV testing and maternal child health outcomes were compared at 6 months postpartum.Results:Of 1101 women screened, 620 were eligible and 601 were randomized to HOPE (n = 306) or INVITE (n = 295). At 6 months postpartum, male partners were more than twice as likely [relative risk (RR) = 2.10; 95% CI (CI): 1.81 to 2.42] to have been HIV tested in the HOPE arm [233 (87%)] compared with the INVITE arm [108 (39%)]. Couples in the HOPE arm [192 (77%)] were 3 times as likely (RR = 3.17; 95% CI: 2.53 to 3.98) to have been tested as a couple as the INVITE arm [62 (24%)] and women in the HOPE arm [217 (88%)] were also twice as likely (RR = 2.27; 95% CI: 1.93 to 2.67) to know their partner's HIV status as the INVITE arm [98 (39%)]. More serodiscordant couples were identified in the HOPE arm [33 (13%)] than in the INVITE arm [10 (4%)] (RR = 3.38; 95% CI: 1.70 to 6.71). Maternal child health outcomes of facility delivery, postpartum family planning, and exclusive breastfeeding did not vary by arm.Conclusions:Home-based HIV testing for pregnant couples resulted in higher uptake of male partner and couple testing, as well as higher rates of HIV status disclosure and identification of serodiscordant couples. However, the intervention did not result in higher uptake of maternal child health outcomes, because facility delivery and postpartum family planning were high in both arms, whereas exclusive breastfeeding was low. The HOPE intervention was successful at its primary aim to increase HIV testing and disclosure among pregnant couples and was able to find more serodiscordant couples compared with the invitation-only strategy.Trial Registration:Clinicaltrials.gov registry: NCT01784783.

Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study

Increased uptake of HIV testing by men in sub-Saharan Africa is essential for the success of combination prevention. Self-testing is an emerging approach with high acceptability, but little evidence exists on the best strategies for test distribution. We assessed an approach of providing multiple self-tests to women at high risk of HIV acquisition to promote partner HIV testing and to facilitate safer sexual decision making. In this cohort study, HIV-negative women aged 18-39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and a drop-in centre for female sex workers. Participants gave informed consent and were instructed on use of oral fluid based rapid HIV tests. Participants enrolled at the health facility received three self-tests and those at the drop-in centre received five self-tests. Structured interviews were conducted with participants at enrolment and over 3 months to determine how self-tests were used. Outcomes included the number of self-tests distributed by participants, the proportion of participants whose sexual partners used a self-test, couples testing, and sexual behaviour after self-testing. Between Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up interviews were completed for 265 (96%). Most participants with primary sexual partners distributed self-tests to partners: 53 (91%) of 58 participants in antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female sex workers. 82 (81%) of 101 female sex workers distributed more than one self-test to commercial sex clients. Among self-tests distributed to and used by primary sexual partners of participants, couples testing occurred in 27 (51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53 (83%) of 64 female sex workers. Among tests received by primary and non-primary sexual partners, two (4%) of 53 tests from participants in antenatal care, two (2%) of 91 in post-partum care, and 41 (14%) of 298 from female sex workers had positive results. Participants reported sexual intercourse with 235 (62%) of 380 sexual partners who tested HIV-negative, compared with eight (18%) of 45 who tested HIV-positive (p<0·0001); condoms were used in all eight intercourse events after positive results compared with 104 (44%) after of negative results (p<0·0018). Four participants reported intimate partner violence as a result of self-test distribution: two in the post-partum care group and two female sex workers. No other adverse events were reported. Provision of multiple HIV self-tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop self-testing policies and programmes. Bill & Melinda Gates Foundation.

Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study

Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study

Home-based HIV testing for men preferred over clinic-based testing by pregnant women and their male partners, a nested cross-sectional study.

BackgroundMale partner HIV testing and counseling (HTC) is associated with enhanced uptake of prevention of mother-to-child HIV transmission (PMTCT), yet male HTC during pregnancy remains low. Identifying settings preferred by pregnant women and their male partners may improve male involvement in PMTCT.MethodsParticipants in a randomized clinical trial (NCT01620073) to improve male partner HTC were interviewed to determine whether the preferred male partner HTC setting was the home, antenatal care (ANC) clinic or VCT center. In this nested cross sectional study, responses were evaluated at baseline and after 6 weeks. Differences between the two time points were compared using McNemar’s test and correlates of preference were determined using logistic regression.ResultsAmong 300 pregnant female participants, 54 % preferred home over ANC clinic testing (34.0 %) or VCT center (12.0 %). Among 188 male partners, 68 % preferred home-based HTC to antenatal clinic (19 %) or VCT (13 %). Men who desired more children and women who had less than secondary education or daily income < $2 USD were more likely to prefer home-based over other settings (p < 0.05 for all comparisons). At 6 weeks, the majority of male (81 %) and female (65 %) participants recommended home over alternative HTC venues. Adjusting for whether or not the partner was tested during follow-up did not significantly alter preferences.ConclusionsPregnant women and their male partners preferred home-based compared to clinic or VCT-center based male partner HTC. Home-based HTC during pregnancy appears acceptable and may improve male testing and involvement in PMTCT.