Increasing male involvement to improve women’s uptake of interventions to reduce the mother to child transmission of HIV

During the past ten years, national governments and international agencies have strengthened the implementation of PMTCT programmes. However, the majority of women still do not access these services. In 2010 there were 390,000 new HIV infections in children, 90% of which were infected through vertical transmission.  Research has shown that fear of violence or abandonment by male partners, cultural gender rules and disparate decision making power for women are among the main reasons that women do not access PMTCT services. Thus interventions should focus on promoting gender equality and improving male awareness and engagement in their families’ health in order to improve uptake of PMTCT services. We aimed to assess the effectiveness of male involvement interventions on women’s uptake of PMTCT services in developing countries. 

We undertook a comprehensive search to identify relevant studies. We found 3,072 references, but only one study that met our criteria. The study was performed in 2003-2004 in Tanzania. Pregnant women in the intervention group were provided with a letter inviting their male partners to accompany them to their next visit, in which they were offered voluntary HIV counselling and testing (VCT) together or separately. Women in the control group received the VCT individually during their first visit. The proportions of women that received VCT and collected their HIV test results were significantly lower in the intervention group than in the control group. Most of the women in the intervention group did not return to the clinic for the subsequent visit and most of those that returned accompanied refused to receive VCT together with their male partners. The invitation letter had a negative impact on the PMTCT uptake in that setting. We urgently need more studies assessing different interventions to improve male engagement in PMTCT to identify the most successful approach for women to safely access health care for their own health and to deliver HIV negative children.  

Authors' conclusions: 

We found only one eligible study that assessed the effectiveness of male involvement in improving women’s uptake of PMTCT services, which only focused on one part of the perinatal PMTCT cascade. We urgently need more rigorously designed studies assessing the impact of male engagement interventions on women’s uptake of PMTCT services to know if this intervention can contribute to improve uptake of PMTCT services and reduce vertical transmission of HIV in children.   

Read the full abstract...
Background: 

Despite efforts to increase the uptake of prevention of mother to child transmission of HIV (PMTCT) services, coverage is still lower than desired in developing countries. A lack of male partner involvement in PMTCT services is a major barrier for women to access these services.

Objectives: 

To evaluate the impact of interventions which aim to enhance male involvement to increase women’s uptake of PMTCT interventions in developing countries.

Search strategy: 

We searched the following databases from the year 2000 to November 2011: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, the WHO Global Health Library, ClinicalTrials.gov, Current Controlled Trials, AEGIS, CROI, IAS, IAC web sites.

Selection criteria: 

We included randomised controlled trials (RCTs), cluster-randomised controlled trials, quasi-randomised controlled trials, controlled before and after studies and interrupted time series studies assessing interventions to increase male involvement for improvement of uptake PMTCT services in low- and middle-income countries..

Data collection and analysis: 

Two reviewers independently searched, screened, assessed study quality and extracted data. A third reviewer resolved any disagreement.

Main results: 

Only one study met the inclusion criteria, an RCT conducted in Tanzania between May 2003 and October 2004. Women in the intervention group (n=760) received a letter for their male partners, which invited them to return together to receive Couple Voluntary Counselling and Testing (CVCT) for HIV. Women in the control group (n=761) received individual HIV VCT during their first ANC visit and then usual care. The percentages of women who received HIV VCT and collected their results were 48%, 45% and 39% in the intervention group and 93%, 78% and 71% in the control group (p <0,001). Only 33% of women in the intervention group returned with their male partners and only 47% of them went through the whole CVCT process. The proportion of women who received HIV prophylaxis at delivery was not different between the two arms (27% in the intervention and 22% in the control group). The study had a high risk of bias.  

Share/Save