Impact of male peer-led outreach on uptake of HIV testing among male partners of pregnant women in Uganda: a randomized trial

IF 4.6 1区 医学 Q2 IMMUNOLOGY
Faith Naddunga, Michelle A. Bulterys, Agnes Nakyanzi, Deborah Donnell, Juliet Kyomugisha, Juliet E. Birungi, Paul Ssendiwala, Rogers Nsubuga, Timothy R. Muwonge, Joshua Musinguzi, Sue Peacock, Connie L. Celum, Andrew Mujugira, Monisha Sharma
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Abstract

Introduction

Male partner HIV testing and engagement in antenatal care (ANC) is associated with improved clinical outcomes for men, pregnant women and infants. However, testing rates remain low among male partners of pregnant women receiving ANC in Africa. We evaluated the impact of male peer outreach to increase HIV testing among partners of pregnant women in Uganda.

Methods

We conducted a randomized trial in Kampala, Uganda, enrolling an equal number of pregnant women with and without HIV from public ANC clinics who were randomized 1:1 to intervention or standard-of-care (SOC) with delayed intervention after 1 month. (ClinicalTrials.gov ID, NCT05388084). The intervention consisted of male peer counsellors calling male partners of consenting pregnant women and inviting them to test for HIV. In the SOC, pregnant women received an invitation letter to deliver to their partners for fast-track HIV testing, per national guidelines. We conducted an intention-to-treat analysis using modified Poisson regression, comparing the proportion of male partners tested for HIV by month 1 across arms overall and by female's HIV status. A secondary analysis compared the proportion tested for HIV by 3 months after both arms received the intervention.

Results

Between May 2022 and March 2023, we enrolled 150 pregnant women (76 in intervention, 74 in SOC). At 1 month, 18% more males in the intervention arm tested for HIV compared to SOC (32% vs. 14%; risk difference [RD] = 0.18; 95% confidence interval [CI]: 0.05–0.31). This association remained significant after stratifying by female HIV status. HIV testing was 22% higher among male partners of HIV-negative women in the intervention arm compared to SOC (46% vs. 24%; RD = 0.22; 95% CI: 0.004–0.430) and 15% higher among partners of pregnant women with HIV (18% vs. 3%; RD = 0.15; 95% CI: 0.02–0.28). At 3 months, 50% (38/76) of male partners tested in the intervention versus 35% (26/74) in the SOC/delayed intervention (RD = 0.15; 95% CI: −0.01 to 0.31).

Conclusions

Male peer outreach is a promising intervention to increase knowledge of HIV status among partners of pregnant women. Additional support is needed to increase HIV testing among partners of women with HIV.

男性同伴主导的外展对乌干达孕妇男性伴侣接受艾滋病毒检测的影响:一项随机试验
男性伴侣艾滋病毒检测和参与产前保健(ANC)与改善男性、孕妇和婴儿的临床结果有关。然而,在非洲接受ANC治疗的孕妇的男性伴侣中,检测率仍然很低。我们评估了男性同伴外展对乌干达孕妇伴侣中增加艾滋病毒检测的影响。方法我们在乌干达坎帕拉进行了一项随机试验,从公立ANC诊所招募了相同数量的感染和未感染艾滋病毒的孕妇,她们按1:1的比例随机分为干预组或延迟干预的标准护理组(SOC)。(ClinicalTrials.gov ID, NCT05388084)。干预包括男性同伴辅导员打电话给同意怀孕妇女的男性伴侣,并邀请他们进行艾滋病毒检测。根据国家指导方针,在SOC中,孕妇会收到一封邀请函,将其交给伴侣进行快速艾滋病毒检测。我们使用修正泊松回归进行了意向治疗分析,比较了男性伴侣在第一个月进行艾滋病毒检测的比例和女性的艾滋病毒状态。第二次分析比较了两组接受干预后3个月的HIV检测比例。在2022年5月至2023年3月期间,我们招募了150名孕妇(76名干预组,74名SOC组)。在1个月时,干预组的男性HIV检测比SOC多18%(32%对14%;风险差[RD] = 0.18;95%置信区间[CI]: 0.05-0.31)。在按女性艾滋病毒状况分层后,这种关联仍然显著。与SOC相比,干预组中HIV阴性女性的男性伴侣的HIV检测高出22%(46%对24%;Rd = 0.22;95% CI: 0.004-0.430),在感染艾滋病毒的孕妇伴侣中高出15%(18%对3%;Rd = 0.15;95% ci: 0.02-0.28)。在3个月时,50%(38/76)的男性伴侣接受了干预测试,而35%(26/74)的男性伴侣接受了SOC/延迟干预测试(RD = 0.15;95% CI:−0.01 ~ 0.31)。结论男性同伴外展是一种很有希望的干预措施,可以提高孕妇伴侣对艾滋病毒状况的了解。需要更多的支持,以增加对感染艾滋病毒妇女的伴侣进行艾滋病毒检测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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