title: Male Partner Participation in Antenatal Clinic Services is Associated With Improved HIV-Free Survival Among Infants in Nairobi, Kenya: A Prospective Cohort Study.
abstract: This prospective study investigated the relationship between male antenatal clinic (ANC) involvement and infant HIV-free survival.
  
  
  
  From 2009 to 2013, HIV-infected pregnant women were enrolled from 6 ANCs in Nairobi, Kenya and followed with their infants until 6 weeks postpartum. Male partners were encouraged to attend antenatally through invitation letters. Men who failed to attend had questionnaires sent for self-completion postnatally. Multivariate regression was used to identify correlates of male attendance. The role of male involvement in infant outcomes of HIV infection, mortality, and HIV-free survival was examined.
  
  
  
  Among 830 enrolled women, 519 (62.5%) consented to male participation and 136 (26.2%) men attended the ANC. For the 383 (73.8%) women whose partners failed to attend, 63 (16.4%) were surveyed through outreach. In multivariate analysis, male report of previous HIV testing was associated with maternal ANC attendance (adjusted odds ratio = 3.7; 95% CI: 1.5 to 8.9, P = 0.003). Thirty-five (6.6%) of 501 infants acquired HIV or died by 6 weeks of life. HIV-free survival was significantly greater among infants born to women with partner attendance (97.7%) than those without (91.3%) (P = 0.01). Infants lacking male ANC engagement had an approximately 4-fold higher risk of death or infection compared with those born to women with partner attendance (HR = 3.95, 95% CI: 1.21 to 12.89, P = 0.023). Adjusting for antiretroviral use, the risk of death or infection remained significantly greater for infants born to mothers without male participation (adjusted hazards ratio = 3.79, 95% CI: 1.15 to 12.42, P = 0.028).
  
  
  
  Male ANC attendance was associated with improved infant HIV-free survival. Promotion of male HIV testing and engagement in ANC/prevention of mother-to-child transmission services may improve infant outcomes.
authors.affiliation: *Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI; †Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya; ‡Department of Epidemiology, University of Washington, Seattle, WA; §School of Public Health, Kenyatta University, Nairobi, Kenya; ‖Department of Obstetrics & Gynecology, Kenyatta National Hospital, Nairobi, Kenya; ¶Department of Obstetrics & Gynecology, University of Nairobi, Nairobi, Kenya; **Department of Global Health, University of Washington, Seattle, WA; ††Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya; and ‡‡Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Adam R
authors.initials: AR
authors.lastname: Aluisio
authors.forename: Rose
authors.initials: R
authors.lastname: Bosire
authors.forename: Betz
authors.initials: B
authors.lastname: Bourke
authors.forename: Ann
authors.initials: A
authors.lastname: Gatuguta
authors.forename: James N
authors.initials: JN
authors.lastname: Kiarie
authors.forename: Ruth
authors.initials: R
authors.lastname: Nduati
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
mesh_terms: D005260:Female; D015658:HIV Infections / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007630:Kenya; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D015996:Survival Rate