Research Article: Impact of male partner involvement on mother-to-child transmission of HIV and HIV-free survival among HIV-exposed infants in rural South Africa: Results from a two phase randomised controlled trial

Date Published: June 5, 2019

Publisher: Public Library of Science

Author(s): Sibusiso Sifunda, Karl Peltzer, Violeta J. Rodriguez, Lissa N. Mandell, Tae Kyoung Lee, Shandir Ramlagan, Maria L. Alcaide, Stephen M. Weiss, Deborah L. Jones, Matt A. Price.


The Sub-Saharan Africa region still remains the epicentre of the global HIV/AIDS epidemic. With regards to new paediatric HIV infections, almost 90% of new HIV infections are among children (aged 0–14 years), largely through mother to child transmission. Male Partner Involvement in Prevention of Mother to Child Transmission programmes is now strongly advocated as being key in improving infant outcomes. This study describes the role of Male Partner Involvement on infant HIV infection and mortality survival in the first year among HIV-exposed infants born from HIV positive mothers.

This study was a two-phase, two condition (intervention or control) longitudinal study as part of a clinic-randomized Prevention of Mother to Child Transmission controlled trial. For Phase 1, female participants were recruited without their male partners. In Phase 2, both female and male participants were enrolled in the study as couples in order to encourage active Male Partner Involvement during pregnancy. Participants had two assessments prenatally (8–24 weeks and 32 weeks) and three assessments postnatally (6 weeks, 6 months, and 12 months)

About 1424 women were eligible for recruitment into the study and 18 eligible women declined to participate. All women had a partner; 54% were unmarried, 26% were cohabiting, and 20% were married. Just over half (55%) of the women had been diagnosed with HIV during the current pregnancy. Phase 1 had significantly more HIV-infected infants than Phase 2 at 12-months postpartum (aOR = 4.55 [1.38, 15.07]). Increased depressive symptoms were associated with infant HIV infection at 12-months (aOR = 1.06 [1.01, 1.10]). Phase 1 also had a significantly greater proportion of dead and HIV-infected infants than Phase 2 at 12-months (aOR = 1.98 [1.33, 2.94]).

Male partner involvement in antenatal care is critical in ensuring infant survival and HIV infection among children born to HIV-positive mothers. This study highlights the high risk of ante-and-post natal depression and underscores the need of screening for depression during pregnancy.

ClinicalTrials.Gov; Trial Number NCT02085356.

Partial Text

The Sub-Saharan Africa (SSA) region still remains the epicentre of the global HIV/AIDS epidemic, with Eastern and Southern Africa being the most affected. Among the 1.8 million new HIV infections in 2017, the SSA region accounted for more than half [1]. Regarding new paediatric HIV infections, SSA bears an even greater burden; in 2017, almost 90% of new HIV infections among children (aged 0–14 years) were in SSA [1]. Over the years, large strides have been made, and rates of new HIV infections have shown a sharp decline among children due to the successful implementation of prevention of mother-to-child transmission (PMTCT) programmes [2]. Despite those successes gained from large-scale PMTCT rollout, about 180,000 children were reported to be newly infected with HIV in 2017 (UNAIDS, 2018), and mother-to-child transmission (MTCT) is largely responsible for most new cases in this age group[1,2]. South Africa (SA) has made tremendous progress with its PMTCT programmes and there has been a reduction in neonatal infections in the last decade. However, rural areas and other resource-scarce settings still face challenges in achieving optimal levels of PMTCT implementation in this country [3].

This study examines male partner involvement in the antenatal period as well as other factors that may impact first year MTCT and survival among HIV-exposed infants. To our knowledge, this is one of the first experimental studies conducted in South Africa to assess the impact of MPI on MTCT and survival amongst HIV-exposed infants. More infants seroconverted in Phase 1 of the study compared to Phase 2. Since Phase 2 enrolled women together with their male partners, this suggests that male engagement in PMTCT improves infant outcomes. It must be highlighted that in the first phase of the study MPI was measured through self-report by women enrolled in the study using a male involvement index. However in the second phase the male partners had to also be enrolled in the study and thus this phase went beyond measuring self-reported MPI and also emphasised actual male partner participation in antenatal care.