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Male participation in prevention programs of Mother to child transmission of HIV: A

systematic review to identify barriers, facilitators.

byF Morfaw, L. Mbuagbaw, L. Thabane et al.

Afri-Can Forum, 18th January 2013, Entebbe, Uganda

www.h i vne t . ubc . ca

BACKGROUND

• Pediatric HIV infections are numerous and worrisome especially in Africa.• 2.5M children<15 years infected in 2009, 2.3M Africa.• 260.000 HIV related deaths in children <15 years, 88%

in Africa• MTCT of HIV accounts for 90% childhood HIV

infections.• The virtual elimination of MTCT of HIV is possible!!


BACKGROUND

• PMTCT programs are part of the solution.• Reproductive health services + ANC are tailored for

womens’ needs. •Many reports point to the beneficial effect of male

involvement in PMTCT activities.


BACKGROUND

•“Men are indeed the forgotten half of this equation” (Mohlala et al 2011).


BACKGROUND

• Achieving male involvement in PMTCT is challenging• Reason: lack of evidence based strategies to effectively

engage men in women’s health.• Possible solution: Identify facilitators and barriers of

male partner involvement in PMTCT.


OBJECTIVE

• Identify the facilitators of and barriers to male involvement in PMTCT activities in

order to inform programs aimed at enhancing male partner participation in

PMTCT.


METHODS


RESULTS 1: Barriers to male PMTCT participation

• Societal/cultural barriers:• Perception of ANC as a woman’s place• Cultural norm, men should not participate:

pregnancy is a woman’s affair.

•Male individual factors• Reluctance to learn one’s status• Time conflict for ANC/PMTCT• Avoidance of the burden of care



• Information/Knowledge barriers:•Misconception that your partner’s HIV status is a

proxy of yours• Unawareness of antenatal VCT by men

•Health System barriers• Long waiting times• ANC services are male unfriendly• Distrust in health system confidentiality



• Female factors:•Women avoiding to involve their spouses due to

numerous fears (infidelity, domestic violence, stigma, divorce)

•Relationship dynamics•Weaker relationships• Fidelity within the relationship.



• Disagreement with PMTCT teachings:• PMTCT encourages condom use within couples• Prenatal HIV testing is a late event.


RESULTS 5: Facilitators of male PMTCT participation

• Health system facilitators:• Invitation letters from health services to men• Offering routine voluntary couple counselling• Provision of services during non-working hours• Offering of counselling and testing at sites other

than ANC• Community sensitization activities• Availability of ARV in health centre.



• Relationship dynamics factors:•Monogamous marriage/co-habitation of partners• Discussing PMTCT within the couple• Sero-concordance for HIV

•Male individual factors• Previous male HIV testing• Providing time to consider PMTCT recommendation• Increased male knowledge on HIV and PMTCT.



• Female individual factors• Lack of financial independence• Positive attitudes of women towards result

disclosure.


KEY MESSAGES

•Socio-cultural factors, individual factors and health system factors constitute the main barriers to male involvement in PMTCT•Most pertinent: the societal perception of antenatal care and PMTCT as a woman’s activity.


KEY MESSAGES

•Demonstrated facilitators are health system actions or factors directly tied to the individual.•Most pertinent: active outreach inviting men to

ANC/PMTCT, Male partner and community sensitization, and offering PMTCT services to men at sites other than antenatal care.


KEY MESSAGES

•There is need for health system amendments and context-specific adaptations of public policy on PMTCT services to break down the barriers to and facilitate male PMTCT involvement.


FUTURE PROSPECTS

•Scale Assessing Male Participation in PMTCT programs (SAMP-PMTCT)•Pioneer testing of SAMP-PMTCT in a cross-sectional study in Cameroon.•RCT


ARTICLE http://www.systematicreviewsjournal.com/content/pdf/2046-4053-2-5.pdf


ACKNOWLEDGEMENTS

• This project is supported by the CIHR Canadian HIV Trials Network (CTN) in the form of an international postdoctoral research fellowship awarded to Frederick Morfaw.

• Dr Thabane is a clinical trials mentor for CIHR under the RCT Mentorship Programme and supervisor of Frederick Morfaw.

• Lawrence Mbuagbaw is co-mentoring F. Morfaw


THANKS FOR YOUR KEEN ATTENTION

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