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www.hivnet.ubc.ca
Male participation in prevention programs of Mother to child transmission of HIV: A
systematic review to identify barriers, facilitators.
byF Morfaw, L. Mbuagbaw, L. Thabane et al.
Afri-Can Forum, 18th January 2013, Entebbe, Uganda
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BACKGROUND
• Pediatric HIV infections are numerous and worrisome especially in Africa.• 2.5M children<15 years infected in 2009, 2.3M Africa.• 260.000 HIV related deaths in children <15 years, 88%
in Africa• MTCT of HIV accounts for 90% childhood HIV
infections.• The virtual elimination of MTCT of HIV is possible!!
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BACKGROUND
• PMTCT programs are part of the solution.• Reproductive health services + ANC are tailored for
womens’ needs. •Many reports point to the beneficial effect of male
involvement in PMTCT activities.
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BACKGROUND
•“Men are indeed the forgotten half of this equation” (Mohlala et al 2011).
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BACKGROUND
• Achieving male involvement in PMTCT is challenging• Reason: lack of evidence based strategies to effectively
engage men in women’s health.• Possible solution: Identify facilitators and barriers of
male partner involvement in PMTCT.
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OBJECTIVE
• Identify the facilitators of and barriers to male involvement in PMTCT activities in
order to inform programs aimed at enhancing male partner participation in
PMTCT.
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METHODS
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RESULTS 1: Barriers to male PMTCT participation
• Societal/cultural barriers:• Perception of ANC as a woman’s place• Cultural norm, men should not participate:
pregnancy is a woman’s affair.
•Male individual factors• Reluctance to learn one’s status• Time conflict for ANC/PMTCT• Avoidance of the burden of care
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RESULTS 2: Barriers to male PMTCT participation
• Information/Knowledge barriers:•Misconception that your partner’s HIV status is a
proxy of yours• Unawareness of antenatal VCT by men
•Health System barriers• Long waiting times• ANC services are male unfriendly• Distrust in health system confidentiality
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RESULTS 3: Barriers to male PMTCT participation
• Female factors:•Women avoiding to involve their spouses due to
numerous fears (infidelity, domestic violence, stigma, divorce)
•Relationship dynamics•Weaker relationships• Fidelity within the relationship.
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RESULTS 4: Barriers to male PMTCT participation
• Disagreement with PMTCT teachings:• PMTCT encourages condom use within couples• Prenatal HIV testing is a late event.
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RESULTS 5: Facilitators of male PMTCT participation
• Health system facilitators:• Invitation letters from health services to men• Offering routine voluntary couple counselling• Provision of services during non-working hours• Offering of counselling and testing at sites other
than ANC• Community sensitization activities• Availability of ARV in health centre.
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RESULTS 6: Facilitators of male PMTCT participation
• Relationship dynamics factors:•Monogamous marriage/co-habitation of partners• Discussing PMTCT within the couple• Sero-concordance for HIV
•Male individual factors• Previous male HIV testing• Providing time to consider PMTCT recommendation• Increased male knowledge on HIV and PMTCT.
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RESULTS 7: Facilitators of male PMTCT participation
• Female individual factors• Lack of financial independence• Positive attitudes of women towards result
disclosure.
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KEY MESSAGES
•Socio-cultural factors, individual factors and health system factors constitute the main barriers to male involvement in PMTCT•Most pertinent: the societal perception of antenatal care and PMTCT as a woman’s activity.
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KEY MESSAGES
•Demonstrated facilitators are health system actions or factors directly tied to the individual.•Most pertinent: active outreach inviting men to
ANC/PMTCT, Male partner and community sensitization, and offering PMTCT services to men at sites other than antenatal care.
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KEY MESSAGES
•There is need for health system amendments and context-specific adaptations of public policy on PMTCT services to break down the barriers to and facilitate male PMTCT involvement.
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FUTURE PROSPECTS
•Scale Assessing Male Participation in PMTCT programs (SAMP-PMTCT)•Pioneer testing of SAMP-PMTCT in a cross-sectional study in Cameroon.•RCT
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ARTICLE http://www.systematicreviewsjournal.com/content/pdf/2046-4053-2-5.pdf
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ACKNOWLEDGEMENTS
• This project is supported by the CIHR Canadian HIV Trials Network (CTN) in the form of an international postdoctoral research fellowship awarded to Frederick Morfaw.
• Dr Thabane is a clinical trials mentor for CIHR under the RCT Mentorship Programme and supervisor of Frederick Morfaw.
• Lawrence Mbuagbaw is co-mentoring F. Morfaw
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THANKS FOR YOUR KEEN ATTENTION