School of Public Health

Daisy Krakowiak

Effectiveness of home-based HIV testing and education among partners of pregnant women in Kenya: a mixed methods approach

Male partner involvement has been recognized as an important component of prevention-of-mother-to-child transmission of HIV (PMTCT); however, male antenatal attendance has been difficult to achieve. Home-based testing among pregnant couples may be an effective strategy to test men.

Women attending their first antenatal visit at Kisumu District Hospital in Kenya were screened for eligibility and randomized to home-based education and HIV testing (HOPE) or to written invitations for male partners to attend clinic (INVITE). Of 1101 women screened, 620 were eligible and 601 were randomized either to HOPE (n=306) or INVITE (n=295). At 6 months postpartum, male partners were more than twice as likely (RR=2.10; 95% CI: 1.81-2.42) to have been HIV tested in the HOPE arm (n=233, 87%) compared to the INVITE arm (n=108, 39%). Couples in the HOPE arm (n=192, 77%) were three times more likely (RR=3.17; 95% CI: 2.53-3.98) to have been tested as a couple than the INVITE arm (n=62, 24%) and women in the HOPE arm (n=217, 88%) were also twice as likely (RR=2.27; 95% CI: 1.93-2.67) to know their partner’s HIV status as the INVITE arm (n=98, 39%). More serodiscordant couples (RR=3.38; 95% CI: 1.70-6.71) were identified in the HOPE arm (n=33, 13%) than in the INVITE arm (n=10, 4%).

In qualitative interviews with participants, it was found that home-based couple HIV testing and counseling facilitated partner testing and disclosure, was preferable due to privacy and quality time, and helped participants overcome their fear of testing. Couples also appreciated the efficiency and appropriateness of partner involvement and joint education, and spoke of intervention influence on partner support in pregnancy and postpartum as well as improved relationship due to disclosure. Couples overwhelmingly had positive feedback for the intervention, although had preferences in terms of health advisors, especially having non-local advisors.

Home-based HIV testing among pregnant couples resulted in higher uptake of male testing and couple testing as well as rates of disclosure and identification of serodiscordant couples. This intervention not only has implications for PMTCT, but also for testing men as part of overall HIV testing strategies to reach the UNAIDS 90-90-90 targets by 2020.