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      Impact of approaches in improving male partner involvement in the prevention of mother-to-child transmission (PMTCT) of HIV on the uptake of PMTCT services in sub-Saharan Africa: a protocol of a systematic review and meta-analysis

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      1 , 2 , 3 , 2 , 3
      BMJ Open
      BMJ Publishing Group

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          Abstract

          Introduction

          Several studies have reported approaches used in improving the delivery of prevention of mother-to-child transmission (PMTCT) of HIV services through the involvement of male partners, but evidence from a systematic review is limited. We aim at determining the impact of male partner involvement on PMTCT in sub-Saharan Africa.

          Methods and analysis

          This will be a systematic review of published literature. Interventional and observational studies on male involvement in PMTCT carried out in sub-Saharan Africa will be included irrespective of the year and language of publication. OVID Medline, Embase, PschINFO, and Cochrane database of controlled trials will be searched. After manual searching of articles, authors shall be contacted for further information. 2 authors (NFT and CJ) will independently screen potential articles for eligibility using defined inclusion and exclusion criteria. Critical Appraisal Skills Programme (CASP) tools, Jadad scale and the STROBE checklist will be used for critical appraisal, and the 2 authors will independently assess the quality of articles. Authors will independently extract data from studies using a pre-established data collection form, and any discrepancies will be sorted by a third author (TRK). Outcomes will be analysed using STATA V.12.0. The random effect model will be used to produce forest plots. The heterogeneity χ 2 statistics and I 2 will be used to assess for heterogeneity. Publication bias will be assessed using funnel plots. This protocol is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines.

          Ethics and dissemination

          No ethical approval since included studies will be published studies that had already obtained ethical approvals. The findings will guide HIV programmes on the best approaches towards involving male partners in PMTCT with a view to improving PMTCT services in sub-Saharan Africa.

          PROSPERO registration number

          42016032673.

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          Most cited references16

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          Recruiting male partners for couple HIV testing and counselling in Malawi's option B+ programme: an unblinded randomised controlled trial.

          Couples HIV testing and counselling (CHTC) is encouraged but is not widely done in sub-Saharan Africa. We aimed to compare two strategies for recruiting male partners for CHTC in Malawi's option B+ prevention of mother-to-child transmission programme: invitation only versus invitation plus tracing and postulated that invitation plus tracing would be more effective.
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            Association between Male Partner Involvement and the Uptake of Prevention of Mother-to-Child Transmission of HIV (PMTCT) Interventions in Mwanza District, Malawi: A Retrospective Cohort Study

            Objective The main objective of this study was to examine the association between male partner involvement and the uptake of prevention of mother-to-child transmission of HIV (PMTCT) interventions. Methods A retrospective cohort study was used to collect data on women, their male partners and their children who were enrolled in a PMTCT program from January 2004 to December 2006 at Mwanza District Hospital. HIV infected women and their children were followed-up over the 18 months postnatal period. Data were analyzed using descriptive statistics, chi-square test and logistic regression. Results A total of 476 HIV positive women were enrolled in a PMTCT program and were followed-up in the study. Of those followed-up in the study, 65 (13.7%) had a male partner involvement while 411 (86.3%) had no male partner involvement. Male partner involvement was significantly associated with condom use (Adjusted odds ratio [AOR] = 5.6, 95% confidence interval [CI]: 2.3–13.5, P<0.001), hospital delivery (AOR = 25.9, 95%CI: 10.6–63.6, P<0.001), and completion of follow-up in the program (AOR = 16.8, 95% CI: 8.5–33.4, P<0.001). Conclusion Male partner involvement increases the uptake of some PMTCT interventions by HIV positive women. Multi-strategic, culturally tailored public health care models are needed to increase the rate of male partner involvement in the program.
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              Home visits during pregnancy enhance male partner HIV counselling and testing in Kenya: a randomized clinical trial.

              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. 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. 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. 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.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2016
                1 July 2016
                : 6
                : 7
                : e012224
                Affiliations
                [1 ]Ministry of Public Health, Cameroon
                [2 ]Institute of Health and Well-being, University of Glasgow , Glasgow, UK
                [3 ]Public Health Protection Unit, NHS Greater Glasgow and Clyde , UK
                Author notes
                [Correspondence to ] Dr Noah F Takah; takahnoah@ 123456yahoo.com
                Article
                bmjopen-2016-012224
                10.1136/bmjopen-2016-012224
                4947788
                27371555
                a1ae6647-93f0-4796-a89d-5d970cb83d21
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 25 April 2016
                : 13 June 2016
                : 15 June 2016
                Categories
                HIV/AIDS
                Protocol
                1506
                1842
                1724

                Medicine
                Medicine

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