Aluisio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. J Acquir Immune Defic Syndr. 2011 Jan 1;56(1):76-82.
A substantial portion of perinatally transmitted HIV infection occurs in the post-partum period through breast feeding. To prevent post-partum transmission, WHO has recommended that HIV-infected women who are breastfeeding infants should either take triple-drug antiretroviral therapy until one week after all exposure to breast milk has ended (option B) or give their infants daily nevirapine prophylaxis until one week after exposure has ended (option A).(1)
The efficacy of option B has recently been confirmed in the Kesho Bora study, a randomized controlled trial conducted in Burkina Faso, Kenya, and South Africa.(2) This, however, is far from universally adopted, and complementary strategies are being examined. One such strategy is involving male partners during pregnancy. It is based on the observation that women whose male partners accompany them to antenatal care are more likely to utilize antiretroviral prophylaxis for prevention of mother-to-child transmission (PMTCT)(3, 4) and are more likely to adhere to PMTCT feeding strategies.(4, 5, 6)
To assess the association between pregnant and post-partum women and their infants being accompanied on clinic visits by the mother's partner on infant outcomes.
Prospective cohort study.
HIV-infected pregnant women attending antenatal clinics in Nairobi, Kenya, between 1999 and 2002.
Interested HIV-infected pregnant women were referred to the study clinic and encouraged to bring their partners. Women were enrolled at 32 weeks gestation and followed with their infants for 12 months post-partum. Women received short-course zidovudine beginning at 34 to 36 weeks' gestation. Infants were evaluated by HIV DNA testing at 48 hours and at 1, 3, 6, 9 and 12 months. Male partners were also enrolled at the antenatal clinic, received counseling on PMTCT and were offered voluntary counseling and testing.
Five hundred ten women were recruited; of these 27 (5%) were lost to follow up before delivery and another 57 (5%) had no current male partner. Of the remaining 456 women, 140 (31%) were accompanied by their male partner, and 316 (69%) were not. Of the 130 male partners, 75 (54%) were tested for HIV, and 42 (56%) of them were infected. Women whose partners attended were more likely to report that their partner had been previously tested for HIV (OR 24.5, 95% CI, 11.5-52.1). Previous testing was also associated with subsequent formula feeding of infants and discussion of feeding practices between partners and to be borderline associated with maternal adherence to zidovudine (OR 1.48, 95% CI 0.96-2.29). After adjusting for maternal viral load and type of infant feeding, infants whose mothers' partners had attended antenatal clinics were less likely to transmit HIV to their infants (adjusted hazard ratio [aHR] 0.56, 95% CI 0.33-0.98) and more likely to have infants survive to 12 months without HIV infection (aHR 0.55, 95% CI 0.35-0.89). These effects similarly found among the infants of the subset of women whose male partners both attended and had been previously tested for HIV (aHR 0.52, 95% CI 0.32-0.84; aHR 0.59, 95% CI 0.39-0.89).
The investigators concluded that infants of HIV-infected women with male partner involvement had a significantly lower risk of HIV infection and greater HIV-free survival compared with infants born to women without male involvement. There was, however, no attempt to ascertain harms, such as domestic violence.
Using the Newcastle-Ottawa scale, this was a high quality study with only 5% lost to follow up.
The implication of this study is that incorporating male partners into PMTCT programs along with HIV counseling and testing can lead to decreased HIV transmission and increased 12-month HIV-free survival. The investigators suggest a need to understand more fully the specific male factors associated with improved infant health outcomes, but, if indeed risk of harm is not increased,(7) it seems reasonable to promote attendance more vigorously even in the absence of additional research.
- World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: towards universal access. Recommendations for a public health approach (2010 version). Geneva: World Health Organization, 2010.
- The Kesho Bora Study Group. Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. Lancet Infect Dis. 2011 Jan 13. [Epub ahead of print].
- Farquhar C, Kiarie JN, Richardson BA, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr. 004;37:1620-26.
- Msuya SE, Mbizvo EM, Hussain A, et al. Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs. AIDS Care. 2008;20:700-09.
- Bii SC, Otieno-Nyunya B, Siika A, et al. Infant feeding practices among HIV infected women receiving prevention of mother-to-child transmission services at Kitale District Hospital, Kenya. East Afr Med J. 2008;85:156-61.
- Matovu A, Kirunda B, Rugamba-Kabagambe G, et al. Factors influencing adherence to exclusive breast feeding among HIV positive mothers in Kabarole district, Uganda. East Afr Med J. 2008;85:162-70.
- Semaru K, Kuhn L, Vwalilka C, et al. Women in couples antenatal HIV counseling and testing are not more likely to report adverse social events. AIDS. 2005; 24:603-09.