Routine Intrapartum HIV Counseling and Testing for Prevention of Mother-to-Child Transmission of HIV in a Rural Ugandan Hospital

University of California, San Francisco, San Francisco, California, United States
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 07/2006; 42(2):149-54. DOI: 10.1097/01.qai.0000225032.52766.c2
Source: PubMed


In Africa, prevention of mother-to-child HIV transmission (PMTCT) programs are hindered by limited uptake by women and their male partners. Routine HIV counseling and testing (HCT) during labor has been proposed as a way to increase PMTCT uptake, but little data exist on the impact of such intervention in a programmatic context in Africa.
In May 2004, PMTCT services were established in the antenatal clinic (ANC) of a 200-bed hospital in rural Uganda; in December 2004, ANC PMTCT services became opt-out, and routine opt-out intrapartum HCT was established in the maternity ward. We compared acceptability, feasibility, and uptake of maternity and ANC PMTCT services between December 2004 and September 2005.
HCT acceptance was 97% (3591/3741) among women and 97% (104/107) among accompanying men in the ANC and 86% (522/605) among women and 98% (176/180) among their male partners in the maternity. Thirty-four women were found to be HIV seropositive through intrapartum testing, representing an 12% (34/278) increase in HIV infection detection. Of these, 14 received their result and nevirapine before delivery. The percentage of women discharged from the maternity ward with documented HIV status increased from 39% (480/1235) to 88% (1395/1594) over the period. Only 2.8% undocumented women had their male partners tested in the ANC in contrast to 25% in the maternity ward. Of all male partners who presented to either unit, only 48% (51/107) came together and were counseled with their wife in the ANC, as compared with 72% (130/180) in the maternity ward. Couples counseled together represented 2.8% of all persons tested in the ANC, as compared with 37% of all persons tested in the maternity ward.
Intrapartum HCT may be an acceptable and feasible way to increase individual and couple participation in PMTCT interventions.

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    • "As to the specific partner’s reaction, majority (27.0% and 22.0%) of them said that he will stop financial support and marriage disruption respectively and a small proportion (11.3% and 4.3%) of them said that he will accept me without complain and give emotional support respectively and this suggests a need to promote couple counseling and testing in the antenatal care clinics as recently shown in Uganda [14]. This finding is also in line with the findings from two rural districts of Zimbabwe [15]. "
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    ABSTRACT: Background All violence against women has serious consequences for their mental, physical wellbeing, reproductive and sexual health including HIV infection and no study was conducted in this regard in Ethiopia and particularly in the present study area. Findings A cross-sectional study was conducted in Gondar town from 22 July–18 August 2011. Of the 400 pregnant women who actively participated in this study, 314 (78.50%) expected a negative reaction for HIV positive test result from their partners. A positive reaction from the partner was associated with women having their own income (Adjusted odds ratio (AOR) (95% CI) =2.18 (1.21, 3.92)), residing in the urban areas (AOR (95% CI) =2.26 (1.21, 4.22)), having education level of secondary level and above (AOR (95% CI) = 6.05 (3.12, 11.72)), not having a stigmatizing attitude towards people living with HIV (AOR (95% CI) = 2.15 (1.24, 3.73)), having a positive attitude towards counselors (AOR (95% CI) = 2.46 (1.42, 4.25)) and being able to access health facilities (AOR (95% CI) = 2.35(1.22, 4.50)). Conclusion Most of the participants in this study expected their partner to react negatively towards a positive HIV test result. Since women’s having their own income is strongly associated with a positive partner’s reaction on HIV test disclosure for prevention of mother to child transmission of HIV services, emphasis should be given for education and economic empowerment of women. A well functioning and accessible health facility with prevention of mother to child transmission of HIV service is important, especially in rural areas.
    BMC Research Notes 03/2013; 6(1):96. DOI:10.1186/1756-0500-6-96
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    • "The studies included were mostly from developing countries. Six of the studies were conducted in Kenya [14–16;25,36,37], five in Uganda [23,32,34,36,37]. Tanzania had four studies [38-41], while Cote d’Ivoire had two [42,43]. "
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    ABSTRACT: Many reports point to the beneficial effect of male partner involvement in programs for the prevention of mother-to-child-transmission (PMTCT) of HIV in curbing pediatric HIV infections. This paper summarizes the barriers and facilitators of male involvement in prevention programs of mother-to-child-transmission of HIV. We searched PubMed, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies published in English from 1998 to March 2012. We included studies conducted in a context of antenatal care or PMTCT of HIV reporting male actions that affected female uptake of PMTCT services. We did not target any specific interventions for this review. We identified 24 studies from peer-reviewed journals; 21 from sub-Saharan Africa, 2 from Asia and 1 from Europe. Barriers to male PMTCT involvement were mainly at the level of the society, the health system and the individual. The most pertinent was the societal perception of antenatal care and PMTCT as a woman’s activity, and it was unacceptable for men to be involved. Health system factors such as long waiting times at the antenatal care clinic and the male unfriendliness of PMTCT services were also identified. The lack of communication within the couple, the reluctance of men to learn their HIV status, the misconception by men that their spouse’s HIV status was a proxy of theirs, and the unwillingness of women to get their partners involved due to fear of domestic violence, stigmatization or divorce were among the individual factors. Actions shown to facilitate male PMTCT involvement were either health system actions or factors directly tied to the individuals. Inviting men to the hospital for voluntary counseling and HIV testing and offering of PMTCT services to men at sites other than antenatal care were key health system facilitators. Prior knowledge of HIV and prior male HIV testing facilitated their involvement. Financial dependence of women was key to facilitating spousal involvement. There is need for health system amendments and context-specific adaptations of public policy on PMTCT services to break down the barriers to and facilitate male PMTCT involvement. Trial Registration The protocol for this review was registered with the International prospective register of systematic reviews (PROSPERO) record CRD42011001703.
    Systematic Reviews 01/2013; 2(1):5. DOI:10.1186/2046-4053-2-5
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    • "In Malawi, records show that missed opportunities for HTC of unknown status women in maternity and labour wards are as high as 63 percent (Bettman et al., 2010). Although regional literature indicates a high acceptance rate of HTC during labour (Homsy et al., 2006), literature from Zimbabwe and Malawi suggests that barriers to HTC access for unknown status women in this setting may include the hesitation of staff to counsel patients because of confidentiality issues, understaffing and the absence of partner approval (Bettman et al., 2010; Perez et al., 2005; Homsy et al., 2007). "
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    ABSTRACT: The CIGI-Africa Initiative Discussion Paper Series presents policy-relevant, peer-reviewed, field-based research that addresses substantive issues in the areas of conflict resolution, energy, food security, health, migration and climate change. The aim of the series is to promote discussion and advance knowledge on issues relevant to policy makers and opinion leaders in Africa. Papers in this series are written by experienced African or Canadian researchers, and have gone through the grant review process. In select cases, papers are commissioned studies supported by the Africa Initiative research program. aBout tHe africa initiative The Africa Initiative is a multi-year, donor-supported program, with three components: a research program, an exchange program and an online knowledge hub, the Africa Portal. A joint undertaking by CIGI, in cooperation with Makerere University and the South African Institute of International Affairs, the Africa Initiative aims to contribute to the deepening of Africa's capacity and knowledge in five thematic areas: conflict resolution, energy, food security, health and migration — with special attention paid to the crosscutting theme of climate change. By incorporating field-based research, strategic partnerships and online collaboration, the Africa Initiative is undertaking a truly interdisciplinary and multi-institutional approach to Africa's governance challenges. Work in the core areas of the initiative focus on supporting innovative research and researchers, and developing policy recommendations as they relate to the program's core thematic areas.
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