title: Role of male partner involvement in ART retention and adherence in Malawi's Option B+ program.
abstract: Malawi's Option B+ program provides all HIV-infected pregnant women free lifelong antiretroviral therapy (ART), but challenges remain regarding retention and ART adherence, potentially due to male partner barriers. We explored relationships between male partner involvement and Option B+ retention and adherence. In 2014, a randomized controlled trial in Malawi compared male recruitment strategies for couple HIV testing and counseling (cHTC) at an antenatal clinic. This secondary analysis was conducted among the entire cohort (N = 200) of women, irrespective of randomization status. We assessed whether cHTC attendance, early disclosure of HIV-positive status, and partner ART reminders were associated with retention and adherence at one month after starting treatment. Retention was defined as attending HIV clinic follow-up within one day of running out of pills. Adherence was defined as taking ≥95% of ARTs by pill count. We used binomial regression to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Median female age was 26 years. Most women (79%) were retained; of these, 68% were adherent. Receiving cHTC was associated with improved retention (aRR 1.33, 95% CI 1.12, 1.59). Receiving male partner ART reminders was weakly associated with retention (aRR 1.16, 95% CI 0.96, 1.39). Disclosure within one day was not associated with retention (aRR 1.08, 95% CI: 0.91, 1.28). Among those who were retained, these three behaviors were not associated with improved 95% adherence. CHTC could play an important role in improving Option B+ retention. Increasing cHTC participation and enhancing adherence-related messages within cHTC are important.
authors.affiliation: a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.
authors.forename: Austin
authors.identifier: 0000-0001-5202-1231
authors.initials: A
authors.lastname: Wesevich
authors.affiliation: a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.
authors.forename: Tiwonge
authors.initials: T
authors.lastname: Mtande
authors.affiliation: a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.
authors.forename: Friday
authors.initials: F
authors.lastname: Saidi
authors.affiliation: b Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cromwell
authors.affiliation: c Lighthouse Trust , Lilongwe , Malawi.|d The International Union Against Tuberculosis and Lung Disease , Paris , France.
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.affiliation: a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.|e Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , USA.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.|e Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , USA.
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
authors.affiliation: b Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , USA.|e Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.affiliation: a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.|b Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , USA.|e Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , USA.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003376:Counseling; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D055118:Medication Adherence / Q000523:psychology*; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012747:Sexual Partners / Q000523:psychology*
chemical_list: D019380:Anti-HIV Agents
keywords: PMTCT; Partner involvement; adherence; option B+; retention