July 22, 2015
Written by Carole Leach-Lemens
This post originally appeared on NAM’s website.
Active invitation and tracing of male partners of pregnant women newly diagnosed with HIV substantially increased uptake of couples HIV counselling and testing (cHCT), resulting in close to half the male partners learning they had HIV for the first time. There was also a significant decline from 94% to 23% (p < 0.001) in unprotected sex among HIV-discordant couples in Lilongwe, Malawi, Nora Rosenberg told participants at the Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015) in Vancouver, Canada on Monday.
The strategies comprised invitation-alone and invitation plus tracing by phone or home visit if the couple did not present for couple HIV counselling and testing within seven days.
This randomised controlled trial recruited pregnant women newly diagnosed with HIV from the Bwaila District Hospital Antenatal Unit between March and October 2014. Uptake of couples HIV counselling and testing by male partners was 52% and 74% in the invitation alone and invitation plus tracing arms of the study, respectively, (p = 0.001).
There were no reports of intimate partner violence. Previous findings have been mixed regarding partner violence as a direct result of couples HIV counselling and testing.
Dr Rosenberg suggested that scale-up of an invitation-plus-tracing recruitment strategy within the Option B+ programme (lifelong ART for women living with HIV who are pregnant or breastfeeding) would have important public health benefits.
In spite of a sevenfold increase in the numbers of women starting antiretroviral therapy in 2011, the first year of the implementation of the Option B+ programme in Malawi, significant challenges remain including uptake, retention in care and adherence to treatment. Loss to follow-up at one year has been reported as being as high as 24% compared to an 8% rate in general health.
While HIV counselling and testing for pregnant women in Malawi’s antenatal programme is close to 100%, couples HIV counselling and testing is rare, even though it is part of the Option B+ guidelines. Findings from a 2014 study showed that few women (11%) came with their partner to the Bwaila District Hospital Antenatal Unit for couples HIV counselling and testing.
Rosenberg noted that couples HIV counselling and testing is critical for women with HIV. Their partners may be unaware of their status and in need of diagnosis and treatment or prevention. The potential benefits of mutual disclosure include the opportunity for them to make informed decisions together about HIV prevention and reproductive health including contraception.