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Table 1 Family-centred PMTCT intervention models: Extension of HIV counselling and testing

From: Family-centred approaches to the prevention of mother to child transmission of HIV

Citation, country, sample size Design Target group Family-centred PMTCT programme components Outcomes Study limitations
[4] Desgrees Du-Lou et al, 2009; Côte d'Ivoire; 710 women Prospective cohort Families Pregnant women were encouraged to suggest HIV testing to partners Free HIV counselling and testing were provided at the request of women's partners and relatives Prenatal HIV counselling and testing of women was followed by increased spousal communication about HIV and sexual risks, irrespective of HIV status (p < 0.01)
This communication was associated with increased HIV testing in male partners (p < 0.05; OR = 4.03; 95% CI 1.50-10.82)
Study conducted among a population participating in a research programme offering routine and systematic prenatal HIV testing and counselling. Thus, the effect of counselling and testing is likely to be higher than in other community settings that do not provide systematic counselling and HIV testing
[22] Farquhar et al, 2004; Kenya; 2836 women and 308 men Prospective cohort Pregnant women and partners Male partners were invited to voluntary counselling and testing (VCT) for HIV at an antenatal clinic Couples were offered post-test counselling
Instruction was provided on contraceptive use, safe sex during pregnancy, and breastfeeding practices
Women whose partners came for VCT (10% of total) were 3 times more likely to return for nevirapine (p = 0.02), and more than 3 times more likely to report taking maternal and administering infant doses of nevirapine (p = 0.009)
Couples post-test counselling was associated with an 8-fold increase in postpartum follow up and greater nevirapine utilization (p = 0.03)
Couples-counselled HIV+ women were more likely to use substitute feeding methods (p = 0.03)
Women whose partners came to the clinic were a select group who may have differed from those whose partners did not come. These differences may have contributed to effects on uptake of interventions.
Since 2001, the approach to PMTCT testing, and the method of drug delivery, has changed considerably
[21] Homsy et al, 2006; Uganda; 4462 women and 287 men Cross- sectional Pregnant/delivering women and partners At a rural hospital, opt-out PMTCT education, HIV testing and counselling was provided to pregnant women in antenatal care, as well as attending partners Opt-out intrapartum HIV counselling/treatment was offered to women and partners
Couples could choose to attend post-test counselling together or individually
Using this opt-out approach, HIV counselling and treatment acceptance was 97% among women and 97% among accompanying partners in the antenatal care (ANC) ward, and 86% among women and 98% among partners in the maternity ward In ANC, only 51 couples (2.8% of all tested persons in ANC) were counselled together
In the maternity ward, 130 couples (37% of all tested persons in maternity) were counselled together
Staffing shortages on evenings and weekends slowed intrapartum HIV counselling and testing uptake until additional labour was hired Given the short follow-up interval, the data did not allow inference as to the rate of hospital delivery among ANC-tested HIV+ women
[20] Kakimoto et al, 2007; Cambodia; 20,757 women and 3714 men Prospective cohort Pregnant women and partners Partners participated in a "mother class" in which information on VCT, pregnancy, delivery and newborn care was provided
VCT was extended to women and their partners, and pre- and post-test couples counselling was offered
85.1% of women accompanied by partners to the mother session accepted pre-test counselling, compared with only 18.7% of women who attended the session alone (p < 0.001; OR = 25.00; 95% CI 22.7-27/8)
Acceptance of post-test counselling was also higher among accompanied women (p < 0.005; OR = 1.2; 95% CI 1.07-1.37)
Pregnant women were voluntary attendees at a health facility and not randomly selected at the community level
[23] Katz et al, 2009; Kenya; 2104 women and 313 men total Prospective cohort Pregnant women and partners Women attending an antenatal clinic were asked to invite and return with their partners to receive couples or individual VCT
Males' attitudes towards VCT were evaluated, as well as the correlates of accompanying partners and receiving couples' counselling
16% of men who were informed by their wives of the availability of HIV testing accompanied their partners to the antenatal clinic
Among 296 couples in which both partners received testing, 39% were counselled as a couple and 57% of men returned for a follow-up visit 87% of men attended the clinic to receive an HIV test, and 11% because they wanted information on HIV or MTCT
The study was conducted in a public antenatal clinic serving an urban population. Therefore, it may not be applicable to other resource-limited settings, including rural communities
[19] Msuya et al, 2008; Tanzania; 2654 women and 332 men Prospective cohort Pregnant women and partners Pregnant women invited their partners to attend antenatal clinics Partners who participated in VCT received HIV, syphilis, and herpes simplex virus 2 testing, as well as pre- and post-test counselling
Couples were invited to a joint counselling session
12.5% of male partners came for HIV counselling and testing 91% of HIV+ women whose partners attended VCT took nevirapine during delivery, compared with 74% of women whose partners didn't attend (OR = 3.45; 95% CI 1.00-12.00) These women were also more likely to choose not to breastfeed and adhere to a selected feeding method (OR = 3.72; 95% CI 1.19-11.63)
Women's intention to disclose test results was associated with partner participation (p < 0.001; OR = 5.15; 95% CI 2.18-12.16)
Low male participation may have been due to failure of women to inform partners of VCT availability The researchers had to rely on women's self reports that they invited their partners
Males may also have gone elsewhere for testing
[6] Semrau et al, 2005; Zambia; 9409 women and 868 men Prospective cohort Pregnant women and partners Within an ongoing study on breastfeeding method and postnatal HIV transmission, women and their partners were offered couples counselling in HIV testing/PMTCT at antenatal clinics
Partner involvement was promoted by community outreach
9.2% of women were accompanied by their partners for counselling Among women counselled as a couple, 96% agreed to HIV testing compared with 79% of women counselled alone (p < 0.0001).
Disclosure inherent in couples counselling did not significantly increase likelihood of adverse social outcomes (e.g., intimate partner violence)
Adverse consequences of disclosure may have been underreported among women who did not disclose HIV status; thus, adverse outcomes may be overestimated by study