Article

Increasing HIV testing among male partners. The Prenahtest ANRS 12127 multi-country randomised trial

aUniversity Bordeaux, ISPED, Centre Inserm U897- Epidemiologie-Biostatistique, F-33000 Bordeaux, France bINSERM, ISPED, Centre Inserm U897- Epidemiologie-Biostatistique, F-33000 Bordeaux, France cLaboratoire d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Yaoundé, Cameroun dCentro Nacional de Investigaciones en Salud Materno Infantil, Santo Domingo, Dominican Republic ePrayas Health Group, Prayas, Pune, India fMaternal and Child Care Union, Neoclinic, Tbilisi, Georgia gInstitut de Recherche pour le Développement, UMR 912 IRD-INSERM-U2, Marseille, France hInstitut de Recherche pour le Développement, CEPED UMR Sorbonne Paris Descartes -INED-IRD, Paris, France iRéseau International des Instituts Pasteurs, Paris, France.
AIDS (London, England) (Impact Factor: 6.56). 01/2013; 27(7). DOI: 10.1097/QAD.0b013e32835f1d8c
Source: PubMed

ABSTRACT OBJECTIVE:: Couple-oriented post-test HIV counselling (COC) provides pregnant women with tools and strategies to invite her partner to HIV counselling and testing. We conducted a randomised trial of the efficacy of COC on partner HIV testing in low/medium HIV prevalence settings (Cameroon, Dominican Republic, Georgia, India). METHODS:: Pregnant women were randomised to receive standard post-test HIV counselling (SC) or COC and followed until six months postpartum. Partner HIV testing events were notified by site laboratories, self-reported by women or both combined. Impact of COC on partner HIV testing was measured in intention-to-treat analysis. Socio-behavioural factors associated with partner HIV testing were evaluated using multivariable logistic regression. RESULTS:: Among 1943 pregnant women enrolled, partner HIV testing rates (combined indicator) were 24.7% among women from COC group vs 14.3% in SC group in Cameroon (Odds Ratio [OR] = 2.0 95%CI [1.2-3.1]), 23.1% vs 20.3% in Dominican Republic (OR = 1.2 [0.8-1.8]), 26.8% vs 1.2% in Georgia (OR = 29.6 [9.1-95.6]) and 35.4% vs 26.6% in India (OR = 1.5 [1.0-2.2]). Women having received COC did not report more conjugal violence or union break-ups than in the SC group. The main factors associated with partner HIV testing were a history of HIV testing among men in Cameroon, Dominican Republic and Georgia and the existence of couple communication around HIV testing in Georgia and India. CONCLUSION:: A simple prenatal intervention taking into account the couple relationship increases the uptake of HIV testing among men in different socio-cultural settings. COC could contribute to the efforts towards eliminating mother-to-child transmission of HIV.

1 Follower
 · 
398 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: HIV testing male partners of pregnant women may decrease HIV transmission to women and promote uptake of prevention of mother-to-child HIV transmission (PMTCT) interventions. However, it has been difficult to access male partners in antenatal care (ANC) clinics. We hypothesized that home visits to offer HIV testing to partners of women attending ANC would increase partner HIV testing. Women attending their first ANC were enrolled, interviewed using smartphone audio-computer assisted self-interviews and randomized to home visits or written invitations for male partners to come to clinic, if they were married or cohabiting, unaccompanied by partners and had no prior couple HIV counselling and testing (CHCT). Enrolled men were offered CHCT (HIV testing and mutual disclosure). Prevalence of CHCT, male HIV seropositivity, couple serodiscordance and intimate partner violence, reported as physical threat from partner, were compared at 6 weeks. Among 495 women screened, 312 were eligible, and 300 randomized to clinic-based or home-based CHCT. Median age was 22 years (interquartile range 20-26 years), and 87% were monogamous. CHCT was significantly higher in home-visit than in clinic-invitation arm (n = 128, 85% vs. n = 54, 36%; P < 0.001). Home-arm identified more HIV-seropositive men (12.0 vs. 8.0%; P = 0.248) and more HIV-discordant couples (14.7 vs. 4.7%; P = 0.003). There was no difference in intimate partner violence. Home visits of pregnant women were safe and resulted in more male partner testing and mutual disclosure of HIV status. This strategy could facilitate prevention of maternal HIV acquisition, improve PMTCT uptake and increase male HIV diagnosis.
    AIDS (London, England) 08/2013; 28(1). DOI:10.1097/QAD.0000000000000023 · 6.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The review summarizes the key new recommendations of the WHO 2013 guidelines for antiretroviral therapy and describes the potential impact of these recommendations on the HIV epidemic. The 2013 WHO guidelines recommend earlier initiation of antiretroviral therapy (ART) at CD4 500 cells/μl or less for all adults and children above 5 years. Further recommendations include initiation of ART irrespective of CD4 cell count or clinical stage for people co-infected with active tuberculosis disease or hepatitis B virus with severe liver disease, pregnant women, people in serodiscordant partnerships, and children under 5 years of age. The ART regimen comprising a once daily fixed-dose combination of tenofovir + lamivudine (or emtricitabine) + efavirenz is recommended as the preferred first-line therapy. Several approaches are also recommended to reach more people and increase health service capacity, including community and self-testing, and task shifting, decentralization, and integration of ART care. If fully implemented, the 2013 WHO ART guidelines could avert at least an additional 3 million deaths and prevent close to an additional 3.5 million new infections between 2012 and 2025 in low- and middle-income countries, compared with previous treatment guidelines.
    Current opinion in HIV and AIDS 10/2013; 8(6). DOI:10.1097/COH.0000000000000008 · 4.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since the beginning of the HIV/AIDS epidemic in India, pregnant women attending antenatal clinics (ANC) have been considered as a low HIV risk population. Yet, a substantial proportion of new HIV infections are occurring among stable heterosexual couples. This paper sought to investigate the proportion and profile of women who, within the low-risk population, are potentially at higher risk of HIV infection. HIV risk perception of pregnant women enrolled within the ANRS 12127 Prenahtest trial was described and associated socio-behavioral characteristics, husband's characteristics, and HIV-related characteristics were analyzed using univariate and multivariate logistic regression models. Among 484 women enrolled, baseline data were collected for 479 women and 460 women with completed data were considered for the present analysis (96%). Eighty-nine (19.4%) women perceived themselves at risk of HIV. Women with educational level
    AIDS Care 11/2013; 26(6). DOI:10.1080/09540121.2013.855303 · 1.60 Impact Factor
Show more