title: Official invitation letters to promote male partner attendance and couple voluntary HIV counselling and testing in antenatal care: an implementation study in Mbeya Region, Tanzania.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin, Berlin, Germany. laurajefferys@gmail.com.
authors.forename: Laura F
authors.initials: LF
authors.lastname: Jefferys
authors.affiliation: PMTCT Program Mbeya Region, Ministry of Health and Social Welfare, Mbeya, Tanzania. philonchimbi07@yahoo.co.uk.
authors.forename: Philo
authors.initials: P
authors.lastname: Nchimbi
authors.affiliation: PMTCT Program Mbeya Region, Ministry of Health and Social Welfare, Mbeya, Tanzania. mbezip@hotmail.com.
authors.forename: Paulina
authors.initials: P
authors.lastname: Mbezi
authors.affiliation: Regional AIDS Control Program Mbeya, Ministry of Health and Social Welfare, Mbeya, Tanzania. easywangi@yahoo.com.
authors.forename: Julius
authors.initials: J
authors.lastname: Sewangi
authors.affiliation: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin, Berlin, Germany. stefanie.theuring@charite.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Theuring
mesh_terms: D000328:Adult; D015709:Correspondence as Topic; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care; D012747:Sexual Partners; D012959:Socioeconomic Factors; D013636:Tanzania