The benefits of male partner involvement in antenatal care
(ANC) and prevention of mother-to-child transmission of HIV (PMTCT) for
maternal and infant health outcomes have been well recognised. However, in many
sub-Saharan African settings, male involvement in these services remains low.
Previous research has suggested written invitation letters as a way to promote
male partner involvement.
In this implementation study conducted at three study sites
in southwest Tanzania, acceptability of written invitation letters for male
partners was assessed. Pre-study CVCT rates of 2–19 % had been recorded at
the study sites. Pregnant women approaching ANC without a male partner were
given an official letter, inviting the partner to attend a joint ANC and couple
voluntary counselling and testing (CVCT) session. Partner attendance was
recorded at subsequent antenatal visits, and the invitation was repeated if the
partner did not attend. Analysis of socio-demographic indices associated
with male partner attendance at ANC was also performed.
Out of 318 women who received an invitation letter for their
partner, 53.5 % returned with their partners for a joint ANC session; of
these, 81 % proceeded to CVCT. Self-reported HIV-positive status at
baseline was negatively associated with partner return (p = 0.033). Male attendance varied
significantly between the rural and urban study sites (p < 0.001) with rates as high as
76 % at the rural site compared to 31 % at the urban health centre.
The majority of women assessed the joint ANC session as a favourable
experience, however 7 (75 %) of women in HIV-positive discordant or
concordant relationships reported problems during mutual disclosure. Beneficial
outcomes reported one month after the session included improved client-
provider relationship, improved intra-couple communication and enhanced sexual
and reproductive health decision-making.
Official invitation letters are a feasible intervention in a
resource limited sub-Saharan African context, they are highly accepted by
couple members, and are an effective way to encourage men to attend ANC and
CVCT. Pre-intervention CVCT rates were improved in all sites. However, urban
settings might require extra emphasis to reach high rates of partner attendance
compared to smaller rural health centres.
Table 3 | ||||||
| Bivariate analysis of factors effecting partner attendance at ANC | ||||||
| Variable | Categories | Study participants N/% | Partner attended N/% | OR | 95 % CI | P value |
| Health facility | Makongolosi | 120/37.7 | 91/75.8 | 7.01 | 3.57–13.74 | <0.001 c |
| Tunduma | 101/31.8 | 49/48.5 | 2.1 | 1.16–3.8 | 0.012 c | |
| Ruanda | 97/30.5 | 30/30.9 | 1 | - | - | |
| Age | <26 years | 218/68.6 | 126/57.8 | 1.74 | 1.08–2.8 | 0.022 c |
| ≥26 years | 100/31.5 | 44/44 | 1 | - | - | |
| Travel time to clinic | ≤15 min | 186/58.5 | 108/58.1 | 1.56 | 0.99–2.46 | 0.051 c |
| >15 min | 132/41.5 | 62/47 | 1 | - | - | |
| Literate | Literate | 301/95.9 | 157/52.2 | 0.33 | 0.088–1.22 | 0.08 c |
| Illiterate | 13/4.1 | 10/76.9 | 1 | - | - | |
| Marital status | Married | 236/74.2 | 143/60.1 | 3.13 | 1.81–5.41 | <0.001 c |
| Partnership | 82/25.8 | 27/32.9 | 1 | - | - | |
| Religion | Christian | 284/90.5 | 149/52.5 | 1 | - | - |
| Muslim + Others | 30/9.5 | 19/63.3 | 1.07 | 0.5–2.32 | 0.86 d | |
| Partners age | ≤26 years | 117/38 | 69/59 | 1.45 | 0.91–2.32 | 0.115 c |
| >26 years | 191/62 | 95/49.7 | 1 | - | - | |
| Partner employment | None | 10/3.6 | 5/50 | 0.81 | 0.23–2.85 | 0.041 e |
| Formal | 24/7.7 | 7/29.2 | 0.33 | 0.13–0.834 | - | |
| Self-employed | 278/89.1 | 154/55.4 | 1 | - | - | |
| Number of children at home | None | 131/46.6 | 67/51.2 | 1 | - | - |
| 1–2 | 110/39.2 | 50/45.6 | 0.79 | 0.48–1.32 | - | |
| >2 | 40/14.2 | 22/55 | 1.17 | 0.57–2.38 | 0.51 e | |
| IPV | IPV reported | 75/24.4 | 28/37.3 | 1 | - | - |
| Not reported | 232 75.6 | 133/57.3 | 2.26 | 1.31–3.39 | 0.003 d | |
| Media | None | 6/1.9 | 2/33.3 | 1 | 0.042 e | |
| Radio | 190/59.8 | 112/59 | 2.87 | 0.51–16.25 | - | |
| Media plus a | 122/38.4 | 56/45.9 | 1.7 | 0.297–9.7 | - | |
| Previous partner attendance at ANC b | Yes | 27/13.9 | 19.4/70.4 | 4.17 | 1.63–10.67 | 0.002 d |
| Self-reported HIV status (baseline) | Positive | 8/2.6 | 1/12.5 | 0.11 | 0.01–0.92 | 0.025 e |
| Negative | 212/68.6 | 121/57.1 | 1 | - | - | |
| Unknown | 89/28.8 | 43/48.3 | 0.7 | 0.43–1.16 | - | |
Full article at:
1Institute of Tropical Medicine and
International Health, Charité-Universitätsmedizin, Berlin, Germany
2PMTCT Program Mbeya Region, Ministry of
Health and Social Welfare, Mbeya, Tanzania
3Regional AIDS Control Program Mbeya,
Ministry of Health and Social Welfare, Mbeya, Tanzania
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