Downloaded from http://journals.lww.com/janac by BhDMf5ePHKbH4TTImqenVGkCDRDhxeyYHBa3oC+LZ2nFS9FVByFyMCm4ICHwiRlq74w4g41IBLs= on 10/13/2020 Research Article Are Male Partners the Missing Link to Eliminating Mother-To-Child Transmission of HIV in Sub- Saharan Africa? Evidence From a Retrospective Case-Control Study Joram Nyandat, MB ChB, MPH* • Gisela Van Rensburg, PhD Abstract When male partners of pregnant women living with HIV do not participate in antenatal care, it decreases the uptake of prevention of mother-to-child transmission interventions, which increases the risk of HIV transmission to newborns. We evaluated the association of male partner involvement and vertical HIV transmission at 6 weeks along 4 constructs: antenatal clinic accompaniment, mother’s awareness of partner HIV status, disclosure of mother’s HIV status to partner, and couple testing. Thirty-three HIV-exposed infants with positive 6-week polymerase chain reaction (PCR) results were compared with 144 HIV-exposed infants with a negative PCR. Mothers of PCR-negative infants were 14 times more likely to have disclosed their HIV status to their partners (odds ratio [OR] 5 14.1 [5.0–39.4]), to be aware of partner HIV status (OR 5 0.2 [0.1–0.96]), and to have been accompanied by their male partners to the antenatal clinic (OR 5 0.6 [0.5–0.9]). There is a need for male engagement in prevention of mother-to-child transmission programs. Key words: disclosure, HIV, partner, perinatal transmission, testing, transmission E limination of mother-to-child transmission (MTCT) of HIV (reduction of MTCT to ,5% and ,1% in breastfeeding and non-breastfeeding population, re- spectively) is a reality (World Health Organization, 2018). In 2017, a number of Caribbean countries joined Cuba, Armenia, Belarus, and Thailand in the growing list of countries that have eliminated MTCT. Many more are on track to achieve this goal. For example, Uganda, South Africa, and Burundi reported reducing MTCT rates by 86%, 84%, and 84%, respectively (Joint United Nations Programme on HIV/AIDS, 2016). However, globally, reduction in MTCT rates has stagnated. De- spite experiencing a more than 50% decline in global incidence of HIV infection in children since 2010, an estimated 150,000 children were infected in 2017 (United Nations International Children’s Emergency Fund, 2018). This means that in 2015, approximately 1,000 children, 85% of whom lived in sub-Saharan Africa, were infected with HIV on a daily basis (Joint United Nations Programme on HIV/AIDS, 2016). If not addressed, the projected reduction of new pediatric infections to less than 20,000 by the year 2020 may not be realized (Avert, 2018). In sub-Saharan Africa, several factors interplay to increase the vulnerability of children to perinatally ac- quired HIV infection, including (a) inadequate and physically inaccessible health facilities, (b) limited com- munity awareness about prevention of MTCT (PMTCT) services, and (c) facility-related factors that decrease the uptake of PMTCT services (Cuco et al., 2015; Deressa, Seme, Asefa, Teshome, & Enqusellassie, 2014). Mater- nal factors such as high viral load, advanced maternal HIV-related illnesses, and detectable CD4 1 T cell counts, which correlate directly with infant HIV acqui- sition, have been moderated by universal provision of PMTCT interventions such as combination anti- retroviral therapy (ART) to pregnant and breastfeeding mothers along with infant prophylaxis (Birlie et al., 2016; Villar-Loubet et al., 2013). Consequently, social and behavioral factors have become important drivers of MTCT. Male partner involvement (MPI) in antenatal care has been associated with reduced rates of MTCT and infant mortality (Aluisio et al., 2011). Involvement of male partners simplifies the dynamics of decision-making by women living with HIV (WLWH), which enhances PMTCT clinic attendance, improves uptake and adher- ence to ART for both mother and baby, and is associated with earlier initiation of ART (Aluisio et al., 2011; Madiba & Letsoalo, 2013; Stirratt et al., 2006). More- over, MPI has the effect of enhancing disclosure of HIV status, which provides social and emotional support to pregnant WLWH and a platform for discussion of safe Joram Nyandat, MB ChB, MPH, is a Pediatric Registrar, University of Witwatersrand, Johannesburg, South Africa. Gisela Van Rensburg, PhD, is a Professor, Department of Health Studies College of Human Sciences, University of South Africa, Johannesburg, South Africa. *Corresponding author: Joram Nyandat, e-mail: 1498729@wits.ac.za Copyright © 2019 Association of Nurses in AIDS Care http://dx.doi.org/10.1097/JNC.0000000000000072 Journal of the Association of Nurses in AIDS Care July-August 2020 • Volume 31 • Number 4 439 Copyright © 2019 Association of Nurses in AIDS Care. Unauthorized reproduction of this article is prohibited.