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Adam Aluisio NIH/FIC Research Scholar University of Nairobi/University of Washington

Male partner HIV-1 testing and antenatal clinic attendance associated with reduced infant HIV-1 acquisition and mortality. Adam Aluisio NIH/FIC Research Scholar University of Nairobi/University of Washington. Vertical transmission & infant mortality.

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Adam Aluisio NIH/FIC Research Scholar University of Nairobi/University of Washington

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  1. Male partner HIV-1 testing and antenatal clinic attendance associated with reduced infant HIV-1 acquisition and mortality Adam Aluisio NIH/FIC Research Scholar University of Nairobi/University of Washington

  2. Vertical transmission & infant mortality • Risk of mother-to-child transmission of HIV-1 • With interventions <2% • Without interventions 15-45% • Infant mortality in sub-Saharan Africa • Overall ~100/1000 • HIV-1 infected infants ~1/3

  3. Partner involvement in PMTCT Farquhar, C., et al., JAIDS, 2004.

  4. Objectives • Determine the role of male partner involvement in: • Mother-to-child transmission of HIV-1 • Infant mortality

  5. Methods • Women enrolled at ~32 weeks gestation with 1 year follow-up • Encouraged to invite partners for antenatal clinic attendance and optional VCT services • Male partner data gathered from all female participants • Infants examined monthly and tested for HIV-1 at birth, 1, 3, 6, 9 and 12 months postpartum

  6. Statistical analysis • Correlates of male partner attendance • Pearson X2 , independent sample t tests & logistic regression • MTCT of HIV-1 & HIV-1-free survival • Kaplan-Meier • Cox regression • Adjusting for maternal viral load and infant feeding modality

  7. Study population 535 women enrolled at ~32 weeks gestation 27 (5%) women with no current relationship 52 (10%) women lost to follow-up prior to delivery 201 (44%) male partners previously tested for HIV-1 456 (85%) women in a current relationship included in analysis 316 (69%) women without male partner attendance 140 (31%) women with male partner attendance

  8. Attending male population * N=106

  9. Correlates of male clinic attendance • Female disclosed serostatus to the male partner • (99% of attending males v. 69% of non-attending males) • Reported partner discussion of PMTCT interventions • (76% of attending males v. 40% of non-attending males) • Male partner previously tested for HIV-1 as per female report • (91% of attending males v. 23% of non-attending males) • aOR=20.2; 95% CI 9.5-42.9; P=<0.001

  10. Risk of HIV-1 acquisition aHR=2.38; 95% CI 1.07-5.39 aHR=2.62; 95% CI 1.32-5.21 Not previously HIV tested N=162 Previously HIV tested N=181 No male attendance N=275 Male attendance N=125 Multivariate model adjusted for maternal viral load & infant feeding modality

  11. HIV-1-free survival Proportion of infants alive & HIV-1 negative Log rank P = <0.001 Log rank P = 0.015 Yes (- - -) No (____)

  12. HIV-1-free survival 1Multivariate model adjusted for maternal viral load & infant feeding modality

  13. Summary & implications • Male partner involvement associated with: • reduced risk of MTCT of HIV-1 • increased HIV-1-free survival • Maternal-child health support • financial, physical or emotional • Increasing male antenatal clinic attendance and VCT utilization • increase HIV-1 testing, prevention & treatment www.pepfar.gov/press/81257.htm

  14. University of Nairobi Dorothy Mbori-Ngacha Rose Bosire Ruth Nduati Elizabeth Obimbo Phelgona Otieno Dalton Wamalwa Christine Gichuhi Fred Hutch Cancer Research Center Julie Overbaugh Sandy Emery University of Washington Carey Farquhar Grace John-Stewart Barbara Lohman-Payne Barbra Richardson Acknowledgments Support from NIH: NICHD and Fogarty International Center Thank you to all study staff and participants

  15. Male partner involvement factors • Male partner clinic attendance • Previous male partner HIV-1 testing as per female report • Highly associated X2 (1)=139.1; P=<0.001 • To avoid multi-co-linearity and to represent the affect of each individual factor, the factors were analyzed independently in multivariate models. • Male partner ANC attendance for HIV-1 positive women is promoted in PMTCT of HIV-1 guidelines to achieve greater HIV-1 testing, therefore identifying the specific factor is of less public health importance than identifying that both factors should be undertaken to increase diagnoses and treatment of HIV-1 infected individuals while concurrently improving infant health.

  16. Infant feeding • Mother choosing to breastfeed at time of enrollment and infant exposure to breast milk during the first year of life highly associated • X2 (1)=113.3; P=<0.001 • OR=12.4; 95% CI 7.5-20.5; P =<0.001

  17. Male partner perspective of PMTCT/ANC • Attitude Towards PMTCT • Generally approved of PMTCT interventions (99%) • Approved of infant feeding alternatives (82%) • Perception of obstacles to attending ANC/PMTCT services • Lack of information/knowledge on the existence of services or necessity to go there (49%) • Being too busy/no time (37%) Theuring, S., et al., AIDS Behav, 2009.

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