partner involvement in the prevention of mother-to-child transmission (PMTCT) services
reduced the risks of vertical transmission and infant mortality by more than
40% compared to no involvement according to Adam Aluisio and colleagues in a
prospective cohort study undertaken between 1999 and 2005 in Nairobi, Kenya published
in the January 1st 2011 edition of the Journal
of Acquired Immune Deficiency Syndromes.
involvement, the authors add, may be an underutilised public health
intervention to address both infant HIV infection and mortality in resource-poor
of the estimated 1,000 children infected daily with HIV live in sub-Saharan Africa. Vertical transmission accounts for approximately
95% of infections in children.
though access to antiretrovirals for PMTCT has improved, much more remains to
be done in resource-poor settings. Over one-third of HIV-infected pregnant
women and half of their infants do not get any treatment.
mortality rates in sub-Saharan Africa are the
highest in the world. HIV transmission, infant feeding practices as well as
poverty contribute to this, note the authors. While there is evidence of
diminishing vertical transmission rates, infant mortality remains high.
Improved infant health outcomes necessitate addressing these public health
problems together, they add.
shows that male involvement is associated with better use of PMTCT services. However,
the authors note there is scant evidence of the link between male involvement
and rates of vertical transmission or infant mortality.
1999 to 2002 HIV-infected pregnant women were recruited from antenatal clinics
in Nairobi, Kenya and followed with their
infants for one year. HIV DNA testing was done at birth and then at one, three,
six, nine and 12 months after birth. Women were encouraged to bring their male
partners for HIV prevention counselling and testing.
of a total of 510 HIV-infected women enrolled, a total of 10% (54) were lost to
follow-up before delivery (27) or did not report a current male partner
the remaining 456 female participants, 140 (31%) were accompanied by their male
partners to the antenatal clinic.
the 140 male partners, 75 (54%) were tested for HIV in the antenatal clinic; 42
(56%) tested positive.
441 infants tested, 19% (82) were HIV-infected by one year of age.
maternal viral load into account HIV-infection risk was over 40% lower in infants born to women accompanied by their
male partners compared to those unaccompanied (adjusted hazard ratio
(aHR)=0.56; 95% CI: 0.33-0.98; P=0.042).
same held true with reported prior partner HIV testing compared to no report of
previous partner testing (adjusted hazard ratio (aHR)=0.52; 95% CI: 0.32-0.84;
for maternal viral load and breastfeeding, the combined risk for vertical
transmission or infant death was significantly lower with antenatal partner
attendance than without (aHR=0.55; 95%CI: 0.35-0.88; P=0.012) as well as with reporting
of previous partner testing than without (aHR=0.58; 95% CI: 0.34-0.88; P=0.01).
authors note this study shows that male partner involvement provides a
significantly lower risk for HIV infection as well as improved HIV-free
survival in infants born to HIV-infected women when compared to infants born to
women without male involvement.
these findings are consistent with other studies, this study differs in that
HIV-infection and infant mortality are looked at rather than numbers accessing
an intervention, for example. This finding, the authors note, provides critical
new evidence for male involvement as a potential, currently underused, public health
authors note that while PMTCT programmes in sub-Saharan Africa
promote partner HIV testing they do not specifically encourage antenatal
attendance for partners of HIV-infected women.
findings support the need to further define specific male partner factors that
are associated with improved health outcomes in maternal and child health
programmes, they note. Barriers to partner testing and participation in
antenatal settings also need to be addressed, the authors add.
(16%) infants died, of whom 28 (39%) were HIV-infected, 31 (44%) HIV-
uninfected, and the remaining 12 (17%) of unknown status.
mortality risk among HIV-uninfected infants born to women with antenatal
partner attendance was 63% less than in those whose mothers were unaccompanied.
The authors note that with increasing rates of antenatal HIV testing and
improved antiretroviral treatment HIV-exposed but uninfected children make up
the majority of infants born to HIV-infected mothers. So bringing down the
death rates among this group will provide considerable public health benefits.
the authors also noted a disturbing trend that needs further exploration: increased mortality risk among HIV-infected
infants born to women with partner attendance.
include not taking into account the possible negative effects of male
involvement, in particular domestic violence. The authors suggest these be
monitored in future studies.
second limitation involves bias when answering sensitive questions concerning
HIV testing and disclosure of their partner’s status.
authors conclude that “these data suggest that incorporating men into PMTCT
programmes with associated HIV testing may improve infant health outcomes by
reducing both vertical transmission and mortality among uninfected infants.”