Assessing Strategies for Increasing Male Involvement in Malawi’s Antenatal Program

Overview

In sub-Saharan Africa, engaging men in HIV prevention, care, and treatment has proven challenging. Along all steps of the HIV care-seeking cascade, men exhibit worse care-seeking behaviors than women. They are less likely to be tested for HIV, initiate combination antiretroviral therapy (cART), and be retained in cART care. Additionally, men rarely engage in the care of their female sex partners, even though couple care-seeking is associated with marked improvements in condom use within HIV-discordant couples. Option B+, Malawi's program for providing immediate, lifelong combination antiretroviral therapy (cART) to all HIV-infected pregnant women at the time of diagnosis, is an important entry-point for involving male partners in care. This is a pilot randomized controlled trial (N=200 women) comparing two strategies of male partner involvement within the Option B+ program. In both arms (patient referral and contract referral) women will be encouraged to invite their male partners to accompany them to the clinic for couple HIV counseling and testing. In the contract referral arm, if the couple does not present within one week, the male partner will receive a home visit encouraging them to present to the clinic. We will compare the two arms for 1) uptake of couple HIV counseling and testing (cHCT), 2) uptake of cART for women, and 3) linkage to care for HIV-infected men. Results are expected to inform a larger trial and ultimately improve care-seeking in Malawi's HIV program. Objective 1: Determine acceptability of male partner recruitment for cHTC within an Option B+ context. We will assess acceptability of eligible females to participate in this pilot RCT and reasons for non-participation. Objective 2: Assess whether study arm (patient referral versus contract referral) is associated with cHTC uptake. We will conduct a pilot randomized controlled trial (RCT) of male partner recruitment. This study will contain two arms: patient referral and contract referral for uptake of cHTC (primary outcome).

Full Title of Study: “Assessing Strategies for Increasing Male Involvement in Malawi’s Antenatal Program”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Health Services Research
    • Masking: None (Open Label)
  • Study Primary Completion Date: January 2015

Interventions

  • Behavioral: contract referral
    • A female partner signs a contract saying it is permissible for a community worker to trace a male sex partner in the community.
  • Behavioral: patient referral
    • A patient agrees to recruit their partner using the invitation.

Arms, Groups and Cohorts

  • Active Comparator: Patient referral
    • Women are given an invitation to give to a male partner inviting them to come to the clinic for important pregnancy information
  • Experimental: contract referral
    • Same as control. However, if the male partner does not present, a community worker will trace the partner in the community.

Clinical Trial Outcome Measures

Primary Measures

  • Number of Women Who Came With Their Partners and Received Couple Counseling and Testing
    • Time Frame: three months
    • Based on whether the female partner brings her male partner to the antenatal clinic for couple HIV counseling and testing (as recorded on study case report forms) as the primary measure of uptake. We will compare time to couple HIV counseling and testing between groups using the Kaplan Meier method and a log rank test.

Secondary Measures

  • Female First Option B+ Follow-up Visit
    • Time Frame: three months
    • It will be assessed whether the female participants return for their first Option B+ visit (using the clinic’s routine Option B+ records). The number retained will be compared.
  • Male Linkage to Care
    • Time Frame: one month from male presentation to the clinic
    • It will be assessed whether newly diagnosed HIV-infected male partners are linked to care within one month of learning their HIV positive result with their partner. This will be assessed from abstraction of routine clinic records at Martin Preuss Center.

Participating in This Clinical Trial

Inclusion Criteria

  • 18 years old or 16-17 years old and married – Pregnant – Received a positive HIV-test within the last day – Will be in Lilongwe for the next month – Able and willing to give locator information for >1 male partner in the Bwaila District Hospital catchment area (either a mobile number, a physical address, or both) Exclusion Criteria:

  • Enrolled/enrolling in the PROMISE study – Initially Presenting with a male sex partner

Gender Eligibility: All

Minimum Age: 16 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • University of North Carolina, Chapel Hill
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Nora E Rosenberg, PhD, Principal Investigator, University of North Carolina, Chapel Hill
    • Mina Hosseinipour, MD, Principal Investigator, University of North Carolina, Chapel Hill

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