Prevalence and correlates of non-disclosure of maternal HIV status to male partners: A national survey in Kenya

  • BMC Public Health, Volume 18, No. 1, Year 2018

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Study Justification:
The study aimed to investigate the prevalence and factors associated with non-disclosure of maternal HIV status to male partners in Kenya. This is important because non-disclosure may hinder the utilization of prevention of mother-to-child HIV transmission (PMTCT) interventions, as male partners play a significant role in decision-making within the home, including access to and utilization of health services.
Highlights:
– The study found that non-disclosure of HIV status to male partners was higher among HIV-infected women compared to HIV-uninfected women.
– Factors associated with non-disclosure among HIV-uninfected women included being unmarried, having low income, experiencing intimate partner violence, and partner non-attendance at antenatal care.
– Among HIV-infected women, non-disclosure was less likely if women had salaried employment and if the relationship length was longer.
– Non-disclosure of HIV status to male partners was associated with lower uptake of CD4 testing, antiretroviral use during labor, and provision of antiretrovirals to infants.
Recommendations:
– Facilitating maternal disclosure of HIV status to male partners is crucial to enhance the uptake of PMTCT services.
– Interventions should focus on addressing the barriers to disclosure, such as providing support for unmarried women, addressing intimate partner violence, and promoting partner involvement in antenatal care.
– Efforts should be made to improve economic opportunities for HIV-infected women to increase their ability to disclose their status to partners.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation of PMTCT programs.
– Healthcare providers: Involved in providing counseling and support to pregnant women regarding HIV disclosure.
– Community health workers: Play a role in raising awareness and providing education on the importance of HIV disclosure.
– Non-governmental organizations (NGOs): Can provide support services, including counseling and economic empowerment programs for HIV-infected women.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers on counseling and support for HIV disclosure.
– Development and dissemination of educational materials on the importance of HIV disclosure.
– Implementation of interventions to address intimate partner violence.
– Economic empowerment programs for HIV-infected women.
– Monitoring and evaluation of the impact of interventions on PMTCT uptake.
Please note that the cost items provided are general categories and not actual cost estimates. The actual cost will depend on the specific context and implementation strategy.

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong, but there are some areas for improvement. The study used a large sample size and conducted multivariate logistic regression models to determine correlates of non-disclosure of maternal HIV status to male partners. The study also accounted for facility-level clustering and adjusted for important covariates. However, the abstract could be improved by providing more details about the study population, such as the demographics and characteristics of the mothers and their partners. Additionally, it would be helpful to include information about the response rate and any potential limitations of the study. Overall, the evidence in the abstract is strong, but providing these additional details would enhance the clarity and completeness of the findings.

Background: Prevention of mother-to-child HIV transmission (PMTCT) programs usually test pregnant women for HIV without involving their partners. Non-disclosure of maternal HIV status to male partners may deter utilization of PMTCT interventions since partners play a pivotal role in decision-making within the home including access to and utilization of health services. Methods: Mothers attending routine 6-week and 9-month infant immunizations were enrolled at 141 maternal and child health (MCH) clinics across Kenya from June-December 2013. The current analysis was restricted to mothers with known HIV status who had a current partner. Multivariate logistic regression models adjusted for marital status, relationship length and partner attendance at antenatal care (ANC) were used to determine correlates of HIV non-disclosure among HIV-uninfected and HIV-infected mothers, separately, and to evaluate the relationship of non-disclosure with uptake of PMTCT interventions. All analyses accounted for facility-level clustering, Results: Overall, 2522 mothers (86% of total study population) met inclusion criteria, 420 (17%) were HIV-infected. Non-disclosure of HIV results to partners was higher among HIV-infected than HIV-uninfected women (13% versus 3% respectively, p < 0.001). HIV-uninfected mothers were more likely to not disclose their HIV status to male partners if they were unmarried (adjusted odds ratio [aOR] = 3.79, 95% CI: 1.56-9.19, p = 0.004), had low (≤KSH 5000) income (aOR = 1.85, 95% CI: 1.00-3.14, p = 0.050), experienced intimate partner violence (aOR = 3.65, 95% CI: 1.84-7.21, p < 0.001) and if their partner did not attend ANC (aOR = 4.12, 95% CI: 1.89-8.95, p < 0.001). Among HIV-infected women, non-disclosure to male partners was less likely if women had salaried employment (aOR = 0.42, 95%CI: 0.18-0.96, p = 0.039) and each increasing year of relationship length was associated with decreased likelihood of non-disclosure (aOR = 0.90, 95% CI: 0.82-0.98, p = 0.015 for each year increase). HIV-infected women who did not disclose their HIV status to partners were less likely to uptake CD4 testing (aOR = 0.32, 95% CI: 0.15-0.69, p = 0.004), to use antiretrovirals (ARVs) during labor (OR = 0.38, 95% CI 0.15-0.97, p = 0.042), or give their infants ARVs (OR = 0.08, 95% CI 0.02-0.31, p < 0.001). Conclusion: HIV-infected women were less likely to disclose their status to partners than HIV-uninfected women. Non-disclosure was associated with lower use of PMTCT services. Facilitating maternal disclosure to male partners may enhance PMTCT uptake.

The methodology of the parent study has been described previously [17]. Briefly, we conducted two facility-based cross-sectional surveys of PMTCT effectiveness from June to December 2013. The first, PMTCT-MCH survey evaluated the population-level effectiveness of the national PMTCT program among all women attending randomly selected facilities in seven of eight provinces in Kenya. The second Nyanza oversample survey purposively sampled HIV-infected women attending facilities in Nyanza, a former province with the highest HIV prevalence in Kenya [18]. The PMTCT-MCH survey used probability proportionate to size sampling to randomly sample 120 facilities from among the 540 medium and large facilities across Kenya. The Nyanza Oversample survey included all large facilities in the former Nyanza province (n = 30). Nine facilities in the former Nyanza were included in both surveys, thus a total of 141 facilities were sampled between both surveys. Facilities located in the North Eastern province were excluded due to security concerns and logistic feasibility. All mothers bringing their infants for 6-week or 9-month infant immunizations were eligible to participate. The National PMTCT-MCH survey recruited all eligible mother-infant pairs attending selected facilities during a fixed 5-day recruitment period, regardless of maternal HIV status. The Nyanza Oversample survey recruited all eligible HIV-positive mothers and their infants attending selected facilities in Nyanza during a fixed 10-day recruitment period. Mothers were included in the current analysis if they had data available on HIV status and reported a current male partner. Study staff administered the survey using Open Data Kit on tablet computers. The survey instrument was adapted from previous surveys designed to measure PMTCT effectiveness [19–21], and field tested prior to implementation. The questionnaire included uptake of ANC, maternal HIV testing, non-disclosure of status, partner HIV status, intimate partner violence (IPV), and use of ARVs among HIV-infected women as well as maternal and paternal demographics and reproductive and family planning history. Among HIV exposed infants, ARVs and HIV testing were assessed. IPV was defined by a score ≥ 10.5 on the Hurt Insult Threaten Scream (HITS) scale [22]. Statistical models were analyzed separately for HIV-infected and uninfected women to describe the study population and examine the correlates of non-disclosure in these two unique groups. All analyses accounted for facility-level clustering. We determined correlates of non-disclosure of HIV status and impact of non-disclosure on utilization of PMTCT services using logistic regression models. Multivariate logistic regression was conducted for covariates statistically associated (p < 0.05) with non-disclosure in univariate analysis. We decided a priori to adjust all multivariate models for marital status, relationship length and male partner attendance at ANC based on previous literature which identified relationship stability and partner engagement in care as predictors of disclosure [23]. STATA version 11 (STATA Corp, College Station, Texas, USA) was used to analyze data.

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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Partner Involvement Programs: Develop programs that actively involve male partners in the maternal health process, including antenatal care (ANC) visits, HIV testing, and PMTCT interventions. This could include education and awareness campaigns targeting male partners, as well as incentives for their participation.

2. Mobile Health (mHealth) Solutions: Utilize mobile technology to provide information and support to pregnant women and their partners. This could include SMS reminders for ANC visits, access to educational materials, and communication platforms for sharing HIV status and discussing PMTCT options.

3. Integrated Services: Implement integrated maternal health services that combine HIV testing and PMTCT interventions with routine antenatal and postnatal care. This would ensure that women receive comprehensive care in a single location, reducing the need for multiple visits and improving access to necessary services.

4. Community Health Workers: Train and deploy community health workers to provide education, counseling, and support to pregnant women and their partners. These workers could help facilitate discussions around HIV status disclosure, provide information on PMTCT options, and assist with accessing healthcare services.

5. Addressing Socioeconomic Factors: Develop interventions that address socioeconomic factors associated with non-disclosure of HIV status, such as low income and intimate partner violence. This could include economic empowerment programs, social support networks, and interventions to prevent and respond to violence against women.

It is important to note that these recommendations are based on the specific context and findings of the study mentioned. Further research and evaluation would be needed to determine the effectiveness and feasibility of implementing these innovations.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health is to facilitate maternal disclosure of HIV status to male partners. This recommendation is based on the findings that non-disclosure of maternal HIV status to male partners is associated with lower utilization of Prevention of Mother-to-Child HIV Transmission (PMTCT) interventions.

To implement this recommendation, the following steps can be taken:

1. Strengthen counseling services: Provide comprehensive counseling services to pregnant women, emphasizing the importance of disclosing their HIV status to their male partners. This can be done during antenatal care visits and through community outreach programs.

2. Address barriers to disclosure: Identify and address the barriers that prevent women from disclosing their HIV status to their male partners. These barriers may include fear of stigma, discrimination, and violence. Provide support and resources to help women overcome these barriers.

3. Involve male partners in PMTCT programs: Engage male partners in PMTCT programs by providing education and information about HIV transmission, prevention, and treatment. Encourage their participation in antenatal care visits and provide opportunities for them to be involved in decision-making regarding maternal health.

4. Provide couple-centered care: Implement a couple-centered approach to maternal health, where both partners are actively involved in the care and decision-making process. This can help create a supportive environment for disclosure and increase the uptake of PMTCT interventions.

5. Strengthen healthcare systems: Ensure that healthcare facilities have the necessary resources, infrastructure, and trained healthcare providers to support PMTCT programs and facilitate maternal disclosure. This includes providing access to HIV testing, counseling, and treatment services.

By implementing these recommendations, it is expected that access to maternal health will be improved, leading to increased uptake of PMTCT interventions and better health outcomes for both mothers and infants.
AI Innovations Methodology
Based on the provided description, the study aims to investigate the prevalence and correlates of non-disclosure of maternal HIV status to male partners in Kenya, and evaluate the impact of non-disclosure on the utilization of Prevention of Mother-to-Child HIV Transmission (PMTCT) interventions. The study methodology involved conducting two facility-based cross-sectional surveys, namely the PMTCT-MCH survey and the Nyanza oversample survey. Here is a brief summary of the methodology:

1. Study Design: The study utilized a cross-sectional design to collect data from mothers attending routine 6-week and 9-month infant immunizations at 141 maternal and child health (MCH) clinics across Kenya.

2. Sampling: The PMTCT-MCH survey used probability proportionate to size sampling to randomly select 120 facilities from among 540 medium and large facilities across Kenya. The Nyanza oversample survey included all large facilities in the former Nyanza province (n=30). A total of 141 facilities were sampled between both surveys.

3. Participant Eligibility: All mothers bringing their infants for 6-week or 9-month immunizations were eligible to participate. Mothers were included in the analysis if they had data available on HIV status and reported a current male partner.

4. Data Collection: Trained study staff administered the survey using Open Data Kit on tablet computers. The survey instrument was adapted from previous surveys designed to measure PMTCT effectiveness and included questions on ANC uptake, maternal HIV testing, non-disclosure of status, partner HIV status, intimate partner violence (IPV), use of antiretrovirals (ARVs), and maternal and paternal demographics.

5. Statistical Analysis: Statistical models were analyzed separately for HIV-infected and uninfected women. Logistic regression models were used to determine the correlates of non-disclosure in each group and to evaluate the impact of non-disclosure on the utilization of PMTCT services. Multivariate logistic regression was conducted for covariates that were statistically associated with non-disclosure in univariate analysis. All analyses accounted for facility-level clustering.

6. Software: STATA version 11 (STATA Corp, College Station, Texas, USA) was used for data analysis.

In summary, the study employed a cross-sectional design, conducted surveys at multiple MCH clinics in Kenya, collected data using tablet computers, and analyzed the data using logistic regression models to determine the correlates of non-disclosure and its impact on PMTCT service utilization.

Statistics:
Citations: 21
Authors: 9
Identifiers:
DOI: 10.1186/s12889-018-5567-6
Research Areas:
Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Violence and Injury
Study Countries:
Kenya
Study Design:
Case-Control Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Male & Female
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