Male partner HIV-1 testing and antenatal clinic attendance

associated with reduced infant HIV-1 acquisition and mortality

Adam AluisioNIH/FIC Research Scholar

University of Nairobi/University of Washington

Vertical transmission & infant mortality

• Risk of mother-to-child transmission of HIV-1• With interventions <2%• Without interventions 15-45%

• Infant mortality in sub-Saharan Africa• Overall ~100/1000• HIV-1 infected infants ~1/3

Partner involvement in PMTCT

Farquhar, C., et al., JAIDS, 2004.

Objectives

• Determine the role of male partner involvement in:–Mother-to-child transmission of HIV-1 –Infant mortality

Methods• Women enrolled at ~32 weeks gestation with

1 year follow-up – Encouraged to invite partners for antenatal clinic

attendance and optional VCT services

– Male partner data gathered from all female participants

– Infants examined monthly and tested for HIV-1 at birth, 1, 3, 6, 9 and 12 months postpartum

Statistical analysis• Correlates of male partner attendance

– Pearson X2 , independent sample t tests & logistic regression

• MTCT of HIV-1 & HIV-1-free survival– Kaplan-Meier – Cox regression

• Adjusting for maternal viral load and infant feeding modality

Study population535 women enrolled at ~32 weeks

gestation

316 (69%) women without male partner attendance

140 (31%) women with male partner attendance

456 (85%) women in a current relationship included in analysis

52 (10%) women lost to follow-up prior to

delivery

201 (44%) male partners previously

tested for HIV-1

27 (5%) women with no current

relationship

Attending male population

Characteristics (N=140) Median (IQR)/Freq (%)

Age (years) 31 (27-35)

Duration of relationship (years) 4 (2-7)

Female partner disclosed serostatus 138 (99%)

Discussed PMTCT of HIV-1 interventions with partner* 76 (72%)

Previously tested for HIV-1 as per female participant 128 (91%)

Participant tested in study 75 (54%)

Positive HIV-1 result among those tested 42 (56%)

* N=106

Correlates of male clinic attendance• Female disclosed serostatus to the male partner

– (99% of attending males v. 69% of non-attending males)

• Reported partner discussion of PMTCT interventions – (76% of attending males v. 40% of non-attending males)

• Male partner previously tested for HIV-1 as per female report – (91% of attending males v. 23% of non-attending males)– aOR=20.2; 95% CI 9.5-42.9; P=<0.001

Risk of HIV-1 acquisition

Multivariate model adjusted for maternal viral load & infant feeding modality

aHR=2.62; 95% CI 1.32-5.21

No male attendance

N=275

Male attendance

N=125

Not previously HIV tested

N=162

Previously HIV tested

N=181

aHR=2.38; 95% CI 1.07-5.39

HIV-1-free survival P

rop

ort

ion

of

infa

nts

ali

ve &

HIV

-1 n

eg

ativ

e

Log rank P = <0.001 Yes (- - -)

No (____)

Log rank P = 0.015

HIV-1-free survival

1Multivariate model adjusted for maternal viral load & infant feeding modality

Correlate N aHR (95% CI)1 P value

Male attendance 296 0.41 (0.22-0.79) 0.007

Previous male HIV-1 testing 258 0.47 (0.27-0.81) 0.006

Summary & implications • Male partner involvement associated with:

– reduced risk of MTCT of HIV-1 – increased HIV-1-free survival

• Maternal-child health support– financial, physical or emotional

• Increasing male antenatal clinic attendance and VCT utilization – increase HIV-1 testing, prevention & treatment

www.pepfar.gov/press/81257.htm

AcknowledgmentsUniversity of NairobiDorothy Mbori-NgachaRose BosireRuth NduatiElizabeth ObimboPhelgona OtienoDalton WamalwaChristine Gichuhi

Fred Hutch Cancer Research CenterJulie OverbaughSandy Emery

University of WashingtonCarey FarquharGrace John-StewartBarbara Lohman-PayneBarbra Richardson

Support from NIH: NICHD and Fogarty International Center

Thank you to all study staff and participants

Male partner involvement factors• Male partner clinic attendance• Previous male partner HIV-1 testing as per female report

– Highly associated X2 (1)=139.1; P=<0.001– To avoid multi-co-linearity and to represent the affect of each individual

factor, the factors were analyzed independently in multivariate models.– Male partner ANC attendance for HIV-1 positive women is promoted in

PMTCT of HIV-1 guidelines to achieve greater HIV-1 testing, therefore identifying the specific factor is of less public health importance than identifying that both factors should be undertaken to increase diagnoses and treatment of HIV-1 infected individuals while concurrently improving infant health.

Infant feeding

• Mother choosing to breastfeed at time of enrollment and infant exposure to breast milk during the first year of life highly associated–X2 (1)=113.3; P=<0.001–OR=12.4; 95% CI 7.5-20.5; P =<0.001

Male partner perspective of PMTCT/ANC

• Attitude Towards PMTCT– Generally approved of PMTCT interventions (99%)– Approved of infant feeding alternatives (82%)

• Perception of obstacles to attending ANC/PMTCT services– Lack of information/knowledge on the existence of

services or necessity to go there (49%)– Being too busy/no time (37%)

Theuring, S., et al., AIDS Behav, 2009.