Date Published: January 30, 2019
Publisher: Public Library of Science
Author(s): Semiu Olatunde Gbadamosi, Ijeoma Uchenna Itanyi, William Nii Ayitey Menson, John Olajide Olawepo, Tamara Bruno, Amaka Grace Ogidi, Dina V. Patel, John Okpanachi Oko, Chima Ariel Onoka, Echezona Edozie Ezeanolue, Joan A. Caylà.
Partner HIV testing during pregnancy has remained abysmally low in sub-Saharan Africa, particularly in Nigeria. Males rarely attend antenatal clinics with their female partners, limiting the few opportunities available to offer them HIV testing. In this study, we evaluated the scale-up of the Healthy Beginning Initiative (HBI), a community-driven evidenced-based intervention to increase HIV testing among pregnant women and their male partners. Our objectives were to determine the: (1) male partner participation rate; (2) prevalence of HIV among male partners of pregnant women; (3) factors associated with HIV positivity among male partners of HIV-positive pregnant women.
We reviewed program data of expectant parents enrolled in HBI in Benue State, north-central Nigeria. During HBI, trained lay health workers provided educational and counseling sessions, and offered free onsite integrated testing for HIV, hepatitis B virus and sickle cell genotype to pregnant women and their male partners who participated in incentivized, church-organized baby showers. Each participant completed an interviewer-administered questionnaire on demographics, lifestyle habits, and HIV testing history. Chi-square test was used to compare the characteristics of HIV-positive and HIV-negative male partners. Simple and multivariable logistic regression models were used to determine the association between participants’ characteristics and HIV positivity among male partners of HIV-positive women.
Male partner participation rate was 57% (5264/9231). Overall HIV prevalence was 6.1% (891/14495) with significantly higher rates in women (7.4%, 681/9231) compared to men (4.0%, 210/5264). Among the 681 HIV-positive women, 289 male partners received HIV testing; 37.7% (109/289) were found to be HIV-positive. In multivariate analysis, older age (adjusted odds ratio [aOR]: 2.45, 95% confidence interval [CI]: 1.27–4.72 for age 30–39 years vs. <30 years; aOR: 2.39, CI: 1.18–4.82 for age ≥40 years vs. <30 years) and self-reported daily alcohol intake (vs. never (aOR: 0.35, CI: 0.13–0.96)) were associated with HIV positivity in male partners of HIV-positive women. The community-based congregational approach is a potential strategy to increase male partner HIV testing towards achieving the UNAIDS goal of 90% HIV screening. Targeting male partners of HIV-positive women for screening may provide a higher yield of HIV diagnosis and the opportunity to engage known positives in care in this population.
HIV testing services (HTS) is recognized as a critical gateway towards achieving epidemic control and meeting the goal of the HIV care cascade promptly. Despite concerted efforts to expand HTS in Nigeria, coverage has consistently remained low among men. The Government of Nigeria estimates a 23.5% HIV testing coverage in the male population. In 2016, among men with new HIV diagnosis in Nigeria, 41% of them received HIV testing in the advanced stage of the disease. Low rates of testing and late HIV diagnosis in men have contributed to high mortality with an estimated 81,000 male deaths attributed to the disease in 2016.
Findings from this study demonstrated that the scale-up of HBI was able to achieve a high male participation rate and that significant gender differences in the prevalence of HIV exist. Also, HIV seropositivity rates among male partners of HIV-positive pregnant women who participated in the HBI was about nine times that of the general male study population.
The community-based congregational approach is a potential strategy to increase male partner HIV testing towards achieving the UN goal of 90% for HIV screening. Targeting male partners of HIV-positive females for screening may provide a higher yield of HIV diagnosis and the opportunity to engage known positives in care in this population.