Home visits during pregnancy enhance male partner HIV counselling and testing in Kenya: a randomized clinical trial.
BACKGROUND
HIV testing male partners of pregnant women may decrease HIV transmission to women and promote uptake of prevention of mother-to-child HIV transmission (PMTCT) interventions. However, it has been difficult to access male partners in antenatal care (ANC) clinics. We hypothesized that home visits to offer HIV testing to partners of women attending ANC would increase partner HIV testing.


METHODS
Women attending their first ANC were enrolled, interviewed using smartphone audio-computer-assisted self-interviews and randomized to home visits or written invitations for male partners to come to clinic, if they were married or cohabiting, unaccompanied by partners and had no prior couple HIV counselling and testing (CHCT). Enrolled men were offered CHCT (HIV testing and mutual disclosure). Prevalence of CHCT, male HIV seropositivity, couple serodiscordance and intimate partner violence, reported as physical threat from partner, were compared at 6 weeks.


RESULTS
Among 495 women screened, 312 were eligible, and 300 randomized to clinic-based or home-based CHCT. Median age was 22 years (interquartile range 20-26 years), and 87% were monogamous. CHCT was significantly higher in home-visit than in clinic-invitation arm (n = 128, 85% vs. n = 54, 36%; P < 0.001). Home-arm identified more HIV-seropositive men (12.0 vs. 8.0%; P = 0.248) and more HIV-discordant couples (14.7 vs. 4.7%; P = 0.003). There was no difference in intimate partner violence.


CONCLUSIONS
Home visits of pregnant women were safe and resulted in more male partner testing and mutual disclosure of HIV status. This strategy could facilitate prevention of maternal HIV acquisition, improve PMTCT uptake and increase male HIV diagnosis.
aDepartment of Obstetrics & Gynecology, AIC Kijabe Hospital, Kijabe, Kenya bDepartment of Epidemiology cDepartment of Global Health dDepartment of Medicine, University of Washington, Seattle, Washington, USA eDepartment of Obstetrics & Gynecology, University of Nairobi, Nairobi, Kenya fDepartment of Biostatistics, University of Washington, Seattle, Washington, USA gDepartment of Obstetrics & Gynecology, Kenyatta National Hospital, Nairobi, Kenya hVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Alfred Onyango
AO
Osoti
Grace
G
John-Stewart
James
J
Kiarie
Barbra
B
Richardson
John
J
Kinuthia
Daisy
D
Krakowiak
Carey
C
Farquhar
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D006792:House Calls; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D011247:Pregnancy; D037841:Pregnant People; D012747:Sexual Partners; D055815:Young Adult