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Significantly better health outcomes are reported for both infants and mothers living with HIV when male partners are co-enrolled in antenatal care with the mother. In this clinic-randomised control trial, infants were 4.55 times less likely to become infected with HIV when male partners were actively involved in prevention of mother-to-child transmission (PMTCT) programmes during pregnancy.

The study took place across 12 randomly selected community health centres in Gert Sibande and Nkangala districts in Mpumalanga province, South Africa.

Researchers compared standard of care PMTCT programs with a new intervention which used group sessions and individual counselling to encourage adherence to treatment, HIV testing of family members, disclosure and partner communication alongside other outcomes.

In the first phase women were enrolled in the intervention or the standard of care alone, while in the second phase they were invited to enrol with their male partners.

The primary outcomes of the trial were infant HIV status, assessed at 12 months by DNA polymerase chain reaction (PCR) test, and infant survival, defined as miscarriage or death by 12 months postpartum. They also collected data on socioeconomic status, knowledge of HIV status, depressive symptoms, HIV stigma, family planning knowledge and intimate partner violence.

A total of 1,399 participants were included in the analysis at baseline. The average (mean) age of the women in the study was 28 and 48% had completed 10 to 11 years of education. Just over half (54%) of the women were unmarried and living separately from their partner and 64% had a monthly income of at least 1,000 ZAR (~70USD). Just over half (55%) of the women had been diagnosed with HIV in this present pregnancy and 50% reported that their pregnancy was unplanned.

The analysis found that more infants became HIV-positive in Phase 1 over Phase 2, and infants whose mothers were enrolled alone had a 1.98% increased likelihood of death or becoming infected with HIV. Moreover, rates of attrition and loss to follow-up were much lower when male partners were involved.

Researchers found that on average, across both phases, women had been diagnosed with HIV 24 months prior to baseline and had been on treatment for 15 months. Male involvement and family planning knowledge were moderate, and HIV-related stigma was low. Depression rates were high, with 45% of women showing clinically significant symptoms of depression. In addition to this, approximately 15% of women reported having more than two alcoholic drinks in the past month, and 61% reported having disclosed their HIV status to their partner. However, of these demographic findings, only depressive symptoms were significantly associated with infant HIV infection at 12 months.

The study found male participation was by far the most significant factor in determining health outcomes of both mother and child, outperforming the ‘protect your family intervention’, which had no significant impact on health outcomes of mother and child compared to standard of care, when women were enrolled alone.

In discussing these findings researchers comment that “male participation in the intervention may have promoted greater male partner involvement overall, including in PMTCT and child nurturing, leading to decreased risk of infant HIV infection and mortality. Male involvement, therefore, should be emphasized in areas with high rates of HIV transmission during or after pregnancy to enhance infant outcomes among HIV-exposed infants.”

Previous programmes primarily focus on mother and child, with little emphasis on the role of the father in pre- and postpartum care. These study results support the shift in thinking and programming that looks at male partner involvement as a critical component of PMTCT.

In this study, depressive symptoms are highlighted as high-risk poor HIV-related outcomes, and interventions should focus on screening for depression in order to improve treatment adherence and decrease infant HIV infection and mortality.

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