AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #262 - Impact of an enhanced prenatal HIV counselling session on communication within the couple
Authors: Presenting Author: Mrs Mélanie Plazy - ISPED, Université Bordeaux Segalen - INSERM U897, Bordeaux, France
Additional Authors: Dr. Joanna Orne-Gliemann, Mr. Eric Balestre, Dr. Marija Miric, Dr. Shirish Darak, Dr. Maia Butsashvili, Dr. Patrice Tchendjou, Prof. François Dabis, Dr. Annabel Desgrees Du Lou,
Aim: Men’s involvement within the prenatal HIV counselling and testing process is key to preventing HIV transmission in the family. The Prenahtest study is investigating the feasibility and impact of a couple-oriented HIV counselling (COC) session, which aims to encourage pregnant women to invite their male partner for HIV testing and couple counselling, and to improve their couple communication about sexual and reproductive health. We report here on the impact of COC on couple communication about HIV.
Method / Issue: Within this 4-country trial (India, Georgia, Dominican Republic and Cameroon), 484 to 491 pregnant women per site were recruited during their first prenatal care visit and individually randomized to receive either standard post-test HIV counselling (SC group) or the intervention (COC group). Women were interviewed at recruitment, before HIV testing (T0), and 2-8 weeks after post-test HIV counselling (T1). Five dichotomous variables documented couple communication about HIV between T0 and T1: 1) HIV status disclosure to the partner, 2) Discussion about HIV, 3) Discussion about condom use, 4) Suggesting HIV testing and 5) Suggesting couple counselling to the partner. The four last indicators were combined within a couple HIV communication index: no communication (“no” answer to the four questions), partial communication (“yes” to one up to three questions) and complete communication (“yes” to the four questions). To estimate the impact of COC on HIV status disclosure, then on the couple HIV communication index, we conducted multivariable logistic regressions adjusted on geographic site and HIV status.
Results / Comments: 1640 women were included in the analysis of whom 56 (3.4%) were HIV-infected. After post-test counselling, HIV-negative women were more likely to disclose their test result to their partner than HIV-infected women (93.4% vs 67.9%, Odds Ratio (OR)=17.2; 95% Confidence Interval (CI)=7.8-37.7). In Georgia, 93.5% of women from the COC disclosed their status to their partner compared to 73.7% in the SC group (OR=5.2; CI=2.9-9.6) but COC was not significantly associated with HIV status disclosure in the other countries, where HIV status disclosure rates were over 96% in both SC and in COC groups. At T1, complete HIV communication was achieved for 22.5% of women and HIV communication was totally absent in 13.9%. In Cameroon, COC was not significantly associated with the HIV couple communication index (p=0.17). However in Dominican Republic, Georgia and India, COC women were more likely to report complete communication about HIV since enrolment, compared to SC women, after adjustment on HIV status (p<0.001 in the three countries).
Discussion: COC improves short-term communication about HIV within the couple in Georgia, Dominican Republic and India, a positive finding for the involvement of men in preventing HIV transmission in the family in these three low HIV prevalence countries (<1%). In Cameroon, where HIV prevalence was the highest (12.1% in our sample), additional and maybe alternative measures aiming at couple communication on HIV should be explored.
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