Abstract #244  -  Optimising PMTCT: the forgotten half of the equation
Authors:   Presenting Author:   Dr Boshi Mohlala - IC
Additional Authors:  Dr Boshishi K.F. Mohlala,
Aim: To assess the acceptability and feasibility of asking pregnant women to invite their male sexual partners to attend ANC and VCT in Khayelitsha, Cape Town, South Africa. Furthermore, to assess whether male sexual partners would attend when invited using a written invitation delivered by their pregnant women and to assess whether an increase in VCT uptake would lead to a decrease in high risk sexual behaviour, and no increase in intimate partner violence.
Method / Issue: We randomised pregnant women to a written invitation to either invite their male sexual partner (MSP) to attend ANC and VCT or to attend ANC and pregnancy information session (PIS). Pregnant women and their male sexual partners were interviewed, using a structured demographic, sexual behaviour and intimate partner violence questionnaires. To ensure confidentiality and promote confidence, participants were interviewed using Informal Confidential Voting Interviews (ICVI) to collect data on sexual behaviour. After the first visit interview, men in the MSP VCT arm were offered VCT and those in the MSP PIS arm were offered PIS.
Results / Comments: In the MSP VCT arm, 35% (175/500) of pregnant women brought their male sexual partners and, in the MSP PIS arm, 26% (129/500) of the pregnant women brought their male sexual partners. The proportion of women bringing male sexual partners to ANC was significantly higher in the MSP VCT arm than in the MSP PIS arm (RR, 1.36; 95% CI, 1.12 to 1.64; P = 0.002). In the MSP VCT arm, 32% (161/500) of pregnant women’s male sexual partners underwent HIV testing and, in the MSP PIS arm, 11% (57/500) of the pregnant women’s male sexual partners underwent HIV testing. The proportion of women’s male sexual partners undergoing testing at the ANC was significantly higher in the MSP VCT arm (RR, 2.82; 95% CI, 2.14 to 3.72; P < 0.000). Intimate partner violence was not different between the two study arms. Intimate partner violence was significantly higher among pregnant women (36%) than among male pregnancy partners (10%) (RR, 3.55; 95% CI 2.46 to 5.11, P<0.0001). Although, the reported sexual activity by men was similar for pregnancy partner in the two weeks before second couple visit, the proportion of sexual activity without condoms was significantly lower in the MSP VCT arm as compared to the MSP PIS arm (26% versus 76%, P<0.001). The numbers of reported sexual acts with pregnancy partners in the two weeks before the second couple visit were significantly higher in the MSP VCT arm as compared to the MSP PIS arm (2 versus 1.4, P = 0.003). However, the numbers of unprotected sexual acts with pregnancy partners in the two weeks prior to second couple visit were significantly lower in the MSP VCT arm than in the MSP PIS arm (0.5 versus 1.1, P = 0.002).
Discussion: Our study suggests that in Khayelitsha - and perhaps in other similar settings in sub-Saharan Africa - it is possible to increase the number of male sexual partners attending HIV testing in ANC and reduce high risk behaviour, without increasing intimate partner violence.
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