Couples' voluntary counselling and testing and nevirapine use in antenatal clinics in two African capitals: a prospective cohort study
Martha Conkling,Erin Shutes,Etienne Karita,Elwyn Chomba,Elwyn Chomba,Amanda Tichacek,Moses Sinkala,Bellington Vwalika,Bellington Vwalika,Melissa Iwanowski,Susan Allen +10 more
TL;DR: The beneficial impact of CVCT on loss to follow up was significant, while nevirapine compliance was similar in women tested alone or with their partners, while weekend CVCT, though new, was feasible in both capital cities.
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Abstract: With the accessibility of prevention of mother to child transmission (PMTCT) services in sub-Saharan Africa, more women are being tested for HIV in antenatal care settings. Involving partners in the counselling and testing process could help prevent horizontal and vertical transmission of HIV. This study was conducted to assess the feasibility of couples' voluntary counseling and testing (CVCT) in antenatal care and to measure compliance with PMTCT. A prospective cohort study was conducted over eight months at two public antenatal clinics in Kigali, Rwanda, and Lusaka, Zambia. A convenience sample of 3625 pregnant women was enrolled. Of these, 1054 women were lost to follow up. The intervention consisted of same-day individual voluntary counselling and testing (VCT) and weekend CVCT; HIV-positive participants received nevirapine tablets. In Kigali, nevirapine syrup was provided in the labour and delivery ward; in Lusaka, nevirapine syrup was supplied in pre-measured single-dose syringes. The main outcome measures were nurse midwife-recorded deliveries and reported nevirapine use. In eight months, 1940 women enrolled in Kigali (984 VCT, 956 CVCT) and 1685 women enrolled in Lusaka (1022 VCT, 663 CVCT). HIV prevalence was 14% in Kigali, and 27% in Lusaka. Loss to follow up was more common in Kigali than Lusaka (33% vs. 24%, p = 0.000). In Lusaka, HIV-positive and HIV-negative women had significantly different loss-to-follow-up rates (30% vs. 22%, p = 0.002). CVCT was associated with reduced loss to follow up: in Kigali, 31% of couples versus 36% of women testing alone (p = 0.011); and in Lusaka, 22% of couples versus 25% of women testing alone (p = 0.137). Among HIV-positive women with follow up, CVCT had no impact on nevirapine use (86-89% in Kigali; 78-79% in Lusaka). Weekend CVCT, though new, was feasible in both capital cities. The beneficial impact of CVCT on loss to follow up was significant, while nevirapine compliance was similar in women tested alone or with their partners. Pre-measured nevirapine syrup syringes provided flexibility to HIV-positive mothers in Lusaka, but may have contributed to study loss to follow up. These two prevention interventions remain a challenge, with CVCT still operating without supportive government policy in Zambia.
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Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis.
Jean B. Nachega,Olalekan A. Uthman,Olalekan A. Uthman,Jean Anderson,Karl Peltzer,Karl Peltzer,Sarah Wampold,Mark F. Cotton,Edward J Mills,Yuh-Shan Ho,Jeffrey S. A. Stringer,Jeffrey S. A. Stringer,James McIntyre,Lynne M. Mofenson +13 more
TL;DR: It is indicated that only 73.5% of pregnant women achieved optimal ART adherence, and specific barriers for nonadherence included physical, economic and emotional stresses, depression, alcohol or drug use, and ART dosing frequency or pill burden.
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TL;DR: The evidence demonstrates the usefulness of couple-based interventions in protecting individuals, partners, and new-born children from the risk of HIV transmission and infection.
Engagement of Men in Antenatal Care Services: Increased HIV Testing and Treatment Uptake in a Community Participatory Action Program in Mozambique
Carolyn M. Audet,Meridith Blevins,Yazalde Manuel Chire,Muktar H. Aliyu,Lara M. E. Vaz,Elisio Antonio,Fernanda Alvim,Ruth Bechtel,C. William Wester,Sten H. Vermund +9 more
TL;DR: A new type of male-to-male community health agent, “Male Champions”, was trained who focused on counseling male partners to create new, male-friendly community norms around engagement in spousal/partner pregnancies to increase testing and treatment acceptability during pregnancy.
The role of male partner in utilization of maternal health care services in Ethiopia: a community-based couple study.
TL;DR: Ethiopia has recorded substantial progress in maternal health recently, and the odds of having at least one ANC visit, first ANC visit within twelve weeks, HIV testing, skilled birth attendant, and birth in a health facility were higher in couples with higher overall male partner involvement.
Intimate partner violence and HIV-positive women's non-adherence to antiretroviral medication for the purpose of prevention of mother-to-child transmission in Lusaka, Zambia
TL;DR: Experiencing intimate partner violence was associated with decreased odds of adherence to PMTCT during and after pregnancy, which deserves increased attention in the effort to eliminate mother-to-child transmission of HIV.
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